Murt A, Altiparmak MR. Rhabdomyolysis-related acute kidney injury in patients with COVID-19. World J Virol 2024; 13(3): 91107 [PMID: 39323452 DOI: 10.5501/wjv.v13.i3.91107]
Corresponding Author of This Article
Ahmet Murt, MD, MSc, Academic Editor, Associate Professor, Researcher, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, TR-34098, Istanbul 34000, Türkiye. ahmet.murt@istanbul.edu.tr
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Virol. Sep 25, 2024; 13(3): 91107 Published online Sep 25, 2024. doi: 10.5501/wjv.v13.i3.91107
Rhabdomyolysis-related acute kidney injury in patients with COVID-19
Ahmet Murt, Mehmet Riza Altiparmak
Ahmet Murt, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34000, Türkiye
Mehmet Riza Altiparmak, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul 34000, Türkiye
Author contributions: Murt A designed and conceptualized the study; Murt A and Altiparmak MR performed data acquisition, analysis, and interpretation; Murt A drafted the first version of the manuscript; and both authors commented on the consecutive versions of the manuscript and approved the final version.
Institutional review board statement: This study was reviewed and approved by Institutional Research Review Board of Cerrahpasa Medical Faculty and by National Scientific Research Council of Ministry of Health (Approval No. 2020-05-08T17_38_07).
Informed consent statement: The need for informed consent was waived due to retrospective nature of this study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: There are no additional data other than analyzed for this study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmet Murt, MD, MSc, Academic Editor, Associate Professor, Researcher, Department of Nephrology Clinic, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, TR-34098, Istanbul 34000, Türkiye. ahmet.murt@istanbul.edu.tr
Received: January 8, 2024 Revised: June 22, 2024 Accepted: July 23, 2024 Published online: September 25, 2024 Processing time: 233 Days and 12.8 Hours
Abstract
BACKGROUND
Viral and bacterial infections may be complicated by rhabdomyolysis, which has a spectrum of clinical presentations ranging from asymptomatic laboratory abnormalities to life-threatening conditions such as renal failure. Direct viral injury as well as inflammatory responses may cause rhabdomyolysis in the course of coronavirus disease 2019 (COVID-19). When presented with acute kidney injury (AKI), rhabdomyolysis may be related to higher morbidity and mortality.
AIM
To compare rhabdomyolysis-related AKI with other AKIs during COVID-19.
METHODS
A total of 115 patients with COVID-19 who had AKI were evaluated retrospectively. Fifteen patients had a definite diagnosis of rhabdomyolysis (i.e., creatine kinase levels increased to > 5 times the upper normal range with a concomitant increase in transaminases and lactate dehydrogenase). These patients were aged 61.0 ± 19.1 years and their baseline creatinine levels were 0.87 ± 0.13 mg/dL. Patients were treated according to national COVID-19 treatment guidelines. They were compared with patients with COVID-19 who had AKI due to other reasons.
RESULTS
For patients with rhabdomyolysis, creatinine reached 2.47 ± 1.17 mg/dL during follow-up in hospital. Of these patients, 13.3% had AKI upon hospital admission, and 86.4% developed AKI during hospital follow-up. Their peak C-reactive protein reached as high as 253.2 ± 80.6 mg/L and was higher than in patients with AKI due to other reasons (P < 0.01). Peak ferritin and procalcitonin levels were also higher for patients with rhabdomyolysis (P = 0.02 and P = 0.002, respectively). The mortality of patients with rhabdomyolysis was calculated as 73.3%, which was higher than in other patients with AKI (18.1%) (P = 0.001).
CONCLUSION
Rhabdomyolysis was present in 13.0% of the patients who had AKI during COVID-19 infection. Rhabdomyolysis-related AKI is more proinflammatory and has a more mortal clinical course.
Core Tip: This study investigated rhabdomyolysis-related acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) and compared it with COVID-19-related AKI due to other causes. Patients with rhabdomyolysis had more inflammation with higher levels of C-reactive protein, procalcitonin, and ferritin. The prognosis of rhabdomyolysis-related AKI was worse than for other forms of COVID-19-related AKI. Patients with inflammatory viral infections such as COVID-19 should be closely followed up for life-threatening conditions such as rhabdomyolysis.
