Acidóse tubular renal distal manifestando-se com rabdomiólise

Zanoteli, Edmar; Oliveira, Acary Souza Bulle de; Tengan, Célia Harumi; Morita, Maria da Penha Ananias; Schmidt, Beny; Gabbai, Alberto Alain

doi:10.1590/S0004-282X1994000400016

Resumos

A hipocalemia severa é causa incomum de rabdomiólise. Descreve-se o caso de urna paciente de 28 anos com acidóse tubular renal distal, que desenvolveu hipocalemia severa com consequente rabdomiólise. O estudo histológico do músculo evidenciou áreas focais de necrose muscular predominando em fibras do tipo II, com discreta reação macrofágica. A melhora clínica e laboratorial apresentada pela paciente ocorreu após a normalização do potássio sérico, tendo sido fundamental, neste caso, a correção da acidóse metabólica.

hipocalemia; rabdomiólise; acidóse tubular renal

Severe hypokalemia is an uncommon cause of rhabdomyolysis. We describe a patient, 28-year-old woman, with distal renal tubular acidosis (DRTA) who developed severe hypokalemia and rhabdomyolysis. Muscle biopsy shows focal muscular necrosis mainly in type II muscle fibers and mild macrophagic reaction. After correcting the acidosis with oral administration of alkalinizing salts, clinical and laboratory improvement was seen. This clearly establish a causal realtionship between the positive acid balance, hypokalemia and the muscular manifestation in DRTA.

hypokalemia; rhabdomyolysis; renal tubular acidosis

Acidóse tubular renal distal manifestando-se com rabdomiólise

Distail renal tubular acidosis manifesting with rhabdomyolysis

Edmar Zanoteli^I; Acary Souza Bulle de Oliveira^I; Célia Harumi Tengan^I; Maria da Penha Ananias Morita^I; Beny Schmidt^II; Alberto Alain Gabbai^I

^IDisciplina de Neurologia, Departamento de Neurologia, Neurocirurgia e Neurologia Experimental, Escola Paulista de Medicina (EPM)

^IIDepartamento de Anatomia Patológica, EPM

RESUMO

A hipocalemia severa é causa incomum de rabdomiólise. Descreve-se o caso de urna paciente de 28 anos com acidóse tubular renal distal, que desenvolveu hipocalemia severa com consequente rabdomiólise. O estudo histológico do músculo evidenciou áreas focais de necrose muscular predominando em fibras do tipo II, com discreta reação macrofágica. A melhora clínica e laboratorial apresentada pela paciente ocorreu após a normalização do potássio sérico, tendo sido fundamental, neste caso, a correção da acidóse metabólica.

Palavras-chave: hipocalemia, rabdomiólise, acidóse tubular renal.

SUMMARY

Severe hypokalemia is an uncommon cause of rhabdomyolysis. We describe a patient, 28-year-old woman, with distal renal tubular acidosis (DRTA) who developed severe hypokalemia and rhabdomyolysis. Muscle biopsy shows focal muscular necrosis mainly in type II muscle fibers and mild macrophagic reaction. After correcting the acidosis with oral administration of alkalinizing salts, clinical and laboratory improvement was seen. This clearly establish a causal realtionship between the positive acid balance, hypokalemia and the muscular manifestation in DRTA.

Key words: hypokalemia, rhabdomyolysis, renal tubular acidosis.

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Agradecimentos - Agradecemos ao Prof. Dr. Nestor Schor, docente da Disciplina de Nefrologia da Escola Paulista de Medicina, pela prestigiosa colaboração na análise e correção deste estudo.

Aceite: 13-junho-1994.

Dr. Acary S.B. Oliveira - Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 740 - 04023-062 São Paulo SP - Brasil.

1. Arruda JAL, Cowell G. Distal renal ácidosis: molecular and clinical aspects. Hosp Pract 1994, 29: 75-88.
2. Bilbrey GL, Herbin L, Carter NW, Knochel JP. Skeletal muscle rcsting membrane potential potassium deficiency. J Clin Invest 1973, 52: 3011-3018.
3. Blachley J, Long J, Knochel JP. The effect of potassium deficiency on resting muscle glycogen content and its response to exercise. Clin Res 1974, 21: 39A.
4. Bywaters EGL, Stead JK. The production of renal failure following injection of solutions containing myohaemoglobin. Q J Exp Physiol 1944, 33: 53-70.
5. Campion DS, Arias JM, Carter NW. Rhadomyolysis and myoglobinuria: association with hypokalemia of renal tubular acidosis. JAMA 1972, 220: 967-969.
6. Comi G, Testa D, Cornelio F, Comola M, Canal N. Potassium depletion myopathy: a clinical and morphological study of six cases. Muscle & Nerve 1985, 8: 17-21.
7. Corbett AJ, Pollock M. Experimental potassium depletion myopathy. J Neurol Sci 1981, 49: 193-206.
8. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine 1982, 61: 141-152.
9. Hanip MR, Cheong IKS, Chin GL, Khalid BAK. Rhabdomyolysis associated with hypokalemic periodic paralysis of renal tubular acidosis. Singapore Med J 1990, 31: 159-161.
10. Heitzman EJ, Patterson JF, Stanley MM. Myoglobinuria and hypokalemia in regional enteritis. Arch Intern Med 1962, 110: 155-162.
11. Johnsen T. Familial periodic paralysis with hypokalaemia. Dan Med Bull 1981, 281: 1-22.
12. Kelts KA, Kaiser KK. Experimental ischemic myopathy: effects of aortic ligation and serotonin. J Neurol Sci 1979, 40: 23-27.
13. Kjellmer I. The potassium ion as a vasodilator during muscular exercise. Acta Physiol Scand 1965, 63: 460-468.
14. Knochel JP. Etiologies and management of potassium deficiency. Hosp Pract 1987, 15: 153-162.
15. Knochel JP. Rhabdomyolysis and myoglobinuria. In Suki WN, Knoyan GE (eds). The kidney in systemic disease. Ed 2. New York: John Wiley & Sons, 1981, p 263-284.
16. Knochel JP, Schlein EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972, 51: 1750-1758.
17. Morris RC Jr, Ives HE. Inherited disordes of the renal tubule. In Brenner BM, Rector FC Jr (eds). The Kidney. Ed 4. Philadelphia: WB. Saunders 1991, Vol II, p 1596-1656.
18. Peni GC, Gorini P. Uraemia in the rabbit after injection of crystalline myoglobin. Br J Exp Pathol 1952, 33: 440-444.
19. Penn AS. Myoglobinuria. In Engel AG, Banker BQ (eds). Myology. New York: McGraw-Hill, 1986, Vol II, p 1785-1805.
20. Rainey RL, Estes PW, Neeley CL, Amick LD. Myoglobinuria following diabetic acidosis with electromyographic evaluation. Arch Intern Med 1963, 111: 564-571.
21. Romanul FCA. Capillary supply and metabolism of muscle fibers. Arch Neurol 1965, 12: 497-509.
22. Singhal PC, Abramovici M, Venkatesan J, Mattana J. Hypokalemia and rhabdomyolysis. Miner Electrolyte Metab 1991, 17: 335-339.
23. Smith SG, Black-Schaffer B, Lasater TE. Potassium deficiency syndrome in the rat and dog. Arch Path 1950, 49: 185-199.
24. Tengan CH, Oliveira ASB, Morita MPA, Kiyomoto BH, Shmidt B, Gabbai AA. Paralisia periódica: estudo anátomo-patológico do músculo esquelético de 14 pacientes. Arq Neuropsiquiatr 1994, 52: 32-40.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Dez 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Arruda JAL, Cowell G. Distal renal ácidosis: molecular and clinical aspects. Hosp Pract 1994, 29: 75-88.

[2] 2. Bilbrey GL, Herbin L, Carter NW, Knochel JP. Skeletal muscle rcsting membrane potential potassium deficiency. J Clin Invest 1973, 52: 3011-3018.

[3] 3. Blachley J, Long J, Knochel JP. The effect of potassium deficiency on resting muscle glycogen content and its response to exercise. Clin Res 1974, 21: 39A.

[4] 4. Bywaters EGL, Stead JK. The production of renal failure following injection of solutions containing myohaemoglobin. Q J Exp Physiol 1944, 33: 53-70.

[5] 5. Campion DS, Arias JM, Carter NW. Rhadomyolysis and myoglobinuria: association with hypokalemia of renal tubular acidosis. JAMA 1972, 220: 967-969.

[6] 6. Comi G, Testa D, Cornelio F, Comola M, Canal N. Potassium depletion myopathy: a clinical and morphological study of six cases. Muscle & Nerve 1985, 8: 17-21.

[7] 7. Corbett AJ, Pollock M. Experimental potassium depletion myopathy. J Neurol Sci 1981, 49: 193-206.

[8] 8. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine 1982, 61: 141-152.

[9] 9. Hanip MR, Cheong IKS, Chin GL, Khalid BAK. Rhabdomyolysis associated with hypokalemic periodic paralysis of renal tubular acidosis. Singapore Med J 1990, 31: 159-161.

[10] 10. Heitzman EJ, Patterson JF, Stanley MM. Myoglobinuria and hypokalemia in regional enteritis. Arch Intern Med 1962, 110: 155-162.

[11] 11. Johnsen T. Familial periodic paralysis with hypokalaemia. Dan Med Bull 1981, 281: 1-22.

[12] 12. Kelts KA, Kaiser KK. Experimental ischemic myopathy: effects of aortic ligation and serotonin. J Neurol Sci 1979, 40: 23-27.

[13] 13. Kjellmer I. The potassium ion as a vasodilator during muscular exercise. Acta Physiol Scand 1965, 63: 460-468.

[14] 14. Knochel JP. Etiologies and management of potassium deficiency. Hosp Pract 1987, 15: 153-162.

[15] 15. Knochel JP. Rhabdomyolysis and myoglobinuria. In Suki WN, Knoyan GE (eds). The kidney in systemic disease. Ed 2. New York: John Wiley & Sons, 1981, p 263-284.

[16] 16. Knochel JP, Schlein EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972, 51: 1750-1758.

[17] 17. Morris RC Jr, Ives HE. Inherited disordes of the renal tubule. In Brenner BM, Rector FC Jr (eds). The Kidney. Ed 4. Philadelphia: WB. Saunders 1991, Vol II, p 1596-1656.

[18] 18. Peni GC, Gorini P. Uraemia in the rabbit after injection of crystalline myoglobin. Br J Exp Pathol 1952, 33: 440-444.

[19] 19. Penn AS. Myoglobinuria. In Engel AG, Banker BQ (eds). Myology. New York: McGraw-Hill, 1986, Vol II, p 1785-1805.

[20] 20. Rainey RL, Estes PW, Neeley CL, Amick LD. Myoglobinuria following diabetic acidosis with electromyographic evaluation. Arch Intern Med 1963, 111: 564-571.

[21] 21. Romanul FCA. Capillary supply and metabolism of muscle fibers. Arch Neurol 1965, 12: 497-509.

[22] 22. Singhal PC, Abramovici M, Venkatesan J, Mattana J. Hypokalemia and rhabdomyolysis. Miner Electrolyte Metab 1991, 17: 335-339.

[23] 23. Smith SG, Black-Schaffer B, Lasater TE. Potassium deficiency syndrome in the rat and dog. Arch Path 1950, 49: 185-199.

[24] 24. Tengan CH, Oliveira ASB, Morita MPA, Kiyomoto BH, Shmidt B, Gabbai AA. Paralisia periódica: estudo anátomo-patológico do músculo esquelético de 14 pacientes. Arq Neuropsiquiatr 1994, 52: 32-40.