Objective To investigate the effect of continuous renal replacement therapy (CRRT) on rhabdomyolysis with acute kidney injury (AKI) following multiple wasp stings. Methods We designed a prospective study which enrolled 132 patients who developed rhabdomyolysis after multiple wasp stings between January 2013 and December 2016 in Jianyang People’s Hospital, West China Hospital of Sichuan University and Anyue People’s Hospital. Among these, 62 patients with AKI were treated with CRRT. The modality of CRRT was continuous veno-venous hemofiltration (CVVH). CVVH was performed for at least 48 hours by using Prismaflex and M100-AN69 hemofilter. Hemofiltration was accomplished using predilution bicarbonate with the replacement fluid rate of 2 000–2 500 mL/h [30–35 mL/(kg·h)]. Heparin or low-molecular-weight heparin was used for anticoagulation, with blood flow rate of 180–200 mL/min. Then intermittent hemodialysis was performed when patients’ condition became stable. Mortality, kidney recovery, biochemical indicators and length of stay were collected. Results Fifty-one patients met the inclusion criteria finally, and four (7.8%) of them died during hospitalization, and the remaining 47 patients survived with completed treatment and follow-up. At 3, 7, and 14 days after treatment, the creatine kinase, myoglobin and lactate dehydrogenase of the patients all decreased significantly and gradually, and returned to normal level finally. Kidney function was recovered in 45 (95.7%) patients within 3 months, and 2 patients suffered chronic kidney disease. The patients’ hemoglobin recovered to normal level at (30.5±11.3) days. Conclusion Rhabdomyolysis and AKI were severe complications following multiple wasp stings, and early CRRT may bring significant benefits to such patients.
ObjectiveTo investigate the protective effects and mechanism of selective histone deacetylases 6 (HDAC6) inhibitor 23BB in myoglobin-induced proximal tubular cell lines (HK-2).MethodsHK-2 cells were divided into 5 groups, including control group, myoglobin (200 μmol/L) group, myoglobin (200 μmol/L)+23BB (1.25 nmol/L) group, myoglobin (200 μmol/L)+4-phenylbutyric acid (2 mmol/L) group, and myoglobin (200 μmol/L)+23BB (1.25 nmol/L)+tunicamycin (25 ng/mL) group. Cells were collected at 24 hours after treatment. The endoplasmic reticulum (ER) stress-related gene mRNA level and marker protein expression were evaluated by RT-PCR and Western blotting, including glucose regulated protein 78 (GRP78), C/EBP homology protein (CHOP), inositol-requiring enzyme 1 (IRE1), PKR-like ER kinase (PERK), and activating transcription factor 6.ResultsIn in vitro study, ER stress-related mRNA of GRP78, IRE1α, PERK, and CHOP and marker protein expression of GRP78 and CHOP were found to increase in response to myoglobin treatment. Either administration of 23BB or 4-PBA could alleviate myoglobin-induced these changes.ConclusionThe protective effect of HDAC6 inhibitor 23BB is through the inhibition of myoglobin-induced ER stress in HK-2 cells.
Objective To identify risk factors for death in patients with rhabdomyolysis-induced acute kidney injury (RI-AKI) treated with continuous renal replacement therapy (CRRT), then to develop and validate the efficacy of prediction models based on these risk factors. Methods Clinical data and prognostic information of patients with RI-AKI requiring CRRT from 2008 to 2019 were extracted from the MIMIC-IV 2.2 database. The enrolled patients were divided into a training set and a test set at a ratio of 7∶3. LASSO regression, random forest (RF) and extreme gradient boosting (XGBoost) were used to identify the risk factors affecting patients’ 28-day survival in the training set, then to develop logistic model, RF model, support vector machine (SVM) model and XGBoost model. The accuracy of above prediction models and the area under the receiver operating characteristic curve (AUC) were calculated in the test set. Results A total of 175 patients were included. Lactic acid, age, Acute Physiology Score Ⅲ, hemoglobin, mean arterial pressure and body mass index measured at intensive care unit admission were identified as the six risk factors affecting 28-day survival of enrolled patients by LASSO regression, RF and XGBoost. The accuracy of the logistic model, RF model, SVM model and XGBoost model in the test set was 0.75, 0.79, 0.79 and 0.81, with the AUC of 0.82, 0.85, 0.87 and 0.87, respectively. Conclusion The XGBoost model, incorporating six risk factors including lactic acid, age, Acute Physiology Score Ⅲ, hemoglobin, mean arterial pressure, and body mass index assessed at the time of admission to the intensive care unit, demonstrates superior clinical predictive performance, thereby enhancing the clinical decision-making process for healthcare professionals.