Tetanus as a cause of acute renal failure: possible role of rhabdomyolysis

Martinelli, Reinaldo; Matos, Cácia M.; Rocha, Heonir

doi:10.1590/S0037-86821993000100001

Abstracts

To study the frequency and examine the role of rhabdomyolysis in the acute renalfailure in tetanus 18 patients with the diagnosis of generalized tetanus consecutively admitted to the infectious disease hospital were evaluated. Ofthese 14 were male and 4female with mean age of 31.8± 2.0 years. Except for mild proteinuria recorded in 9 patients, the urinalysis were unremarkable. Serum creatinine higher than 1.4mg/dl was recorded in 39% of the patients, abnormal levels of CPK in 87,5% and serum myoglobin greater than 120µg/l in 39% of the patients. Oliguria was documented in one patient and none required diafysis therapy. No correlation wasfound between renal failure and myoglobin and/or CPK serum levels. Acute renalfailure in tetanus was not infrequent; usualfy it was non-oliguric, mild and transient and not related to the severity of the disease or to serum levels of myoglobin and/or CPK.

Tetanus; Rhabdomyolysis; Myoglobin; Acute renal failure

Com o objetivo de estudar a freqüência de insuficiêncai renal aguda e o papel da rabdomiólise na sua patogênese, 18 pacientes adultos com o diagnóstico de tétano, consecutivamente admitidos no hospital de doenças infecciosas (Hospital Couto Maia, Salvador, BA)foramprospectivamente avaliados. Destes, 14 eram do sexo masculino e 4 do feminino, com idade média de 31,8± 2,0 anos. Exceto porproteinúria leve a moderada (< 100mg/dl) em 9pacientes, os sumários de urina foram considerados normais. Creatininas séricas superiores a l,4mg/dl foram observadas em 39% dos pacientes, níveis elevados de CPK em 87,5% e mioglobina sérica maior que 120µg/dl em 39%. Oligúria foi documentada em apenas um paciente; nenhum paciente requereu tratamento dialítico. Não foram observadas correlações entre insuficiência renal aguda e níveis séricos de mioglobina e/ou CPK. A insuficiência renal aguda no tétano não foi infreqüente; geralmente é não-oligúrica, de pequena gravidade, transitória e não relacionada à severidade da doença ou aos níveis séricos de mioglobina e/ou CPK.

Tétano; Rabdomiólise; Mioglobina; Insuficiência renal aguda

ARTICLES

Tetanus as a cause of acute renal failure: possible role of rhabdomyolysis

Reinaldo Martinelli; Cácia M. Matos; Heonir Rocha

^{Adress to correspondence} Adress to correspondence: Dr. Reinaldo Martinelli. FACP/ Laboratório de Nefrologia - 1117 Hospital Universitário Prof. Edgard Santos. Rua João das Botas s/n, Canela 40110-160 Salvador, BA, Brasil.

ABSTRACT

To study the frequency and examine the role of rhabdomyolysis in the acute renalfailure in tetanus 18 patients with the diagnosis of generalized tetanus consecutively admitted to the infectious disease hospital were evaluated. Ofthese 14 were male and 4female with mean age of 31.8± 2.0 years. Except for mild proteinuria recorded in 9 patients, the urinalysis were unremarkable. Serum creatinine higher than 1.4mg/dl was recorded in 39% of the patients, abnormal levels of CPK in 87,5% and serum myoglobin greater than 120µg/l in 39% of the patients. Oliguria was documented in one patient and none required diafysis therapy. No correlation wasfound between renal failure and myoglobin and/or CPK serum levels. Acute renalfailure in tetanus was not infrequent; usualfy it was non-oliguric, mild and transient and not related to the severity of the disease or to serum levels of myoglobin and/or CPK.

Keywords: Tetanus. Rhabdomyolysis. Myoglobin. Acute renal failure.

RESUMO

Com o objetivo de estudar a freqüência de insuficiêncai renal aguda e o papel da rabdomiólise na sua patogênese, 18 pacientes adultos com o diagnóstico de tétano, consecutivamente admitidos no hospital de doenças infecciosas (Hospital Couto Maia, Salvador, BA)foramprospectivamente avaliados. Destes, 14 eram do sexo masculino e 4 do feminino, com idade média de 31,8± 2,0 anos. Exceto porproteinúria leve a moderada (< 100mg/dl) em 9pacientes, os sumários de urina foram considerados normais. Creatininas séricas superiores a l,4mg/dl foram observadas em 39% dos pacientes, níveis elevados de CPK em 87,5% e mioglobina sérica maior que 120µg/dl em 39%. Oligúria foi documentada em apenas um paciente; nenhum paciente requereu tratamento dialítico. Não foram observadas correlações entre insuficiência renal aguda e níveis séricos de mioglobina e/ou CPK. A insuficiência renal aguda no tétano não foi infreqüente; geralmente é não-oligúrica, de pequena gravidade, transitória e não relacionada à severidade da doença ou aos níveis séricos de mioglobina e/ou CPK.

Palavras-chave: Tétano. Rabdomiólise. Mioglobina. Insuficiência renal aguda.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 19/11/92.

Department of Medicine, Federal University of Bahia Medical School, Salvador BA Brazil.

This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq, Brazil (Grant n° 407670/85CL).

1. Armitage P, Clifford P. Prognosis in tetanus: use of data from therapeutic trials. Journal of Infectious Diseases 138:1-8, 1978.
2. Barua AR, Ghosh BP. Studies on serum transaminases and creatine-phosphokinase in tetanus. Journal Indian Medical Association 49:376-380, 1968.
3. Brezis M, Rosen S, Epstein FH. Acute renal failure. In: BrennerBM, RectorJrFC (eds) Thekidney, 4th edition, WB Saunders Companhy, Philadelphia p. 993-1062, 1991.
4. Cains JA, Missirlis E, Walker WHC. Usefulness of serial determination of my oglobin and creatinekinase in serum compared for the assessment of acute myocardial infarction. Clinical Chemistry 29:469- 473, 1983.
5. Choo-Kang E, Hanna W. Serum enzymes changes in tetanus. West Indian Medical Journal 29:191- 197, 1980.
6. Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications and mortality in 100 cases. British Medical Journal 1:1401-1404, 1979.
7. Gamier MJ, Marshall FN, Davison KJ, Lepreau Jr FJ. Tetanus in Haiti. Lancet 1:383-386, 1976.
8. Ghanem MH, Khadr AA, Sharabeen MK, Guirgis FK. The skeletal muscle in tetanus. Journal of Tropical Medicine and Hygiene 76:239-242, 1973.
9. Griffin JW. Local tetanus. Johns Hopkins Medical Journal 149:84-88, 1981.
10. Hariparsad D, Pather M, Rocke DA, Wesley AG. Renal function in tetanus. Intensive Care Medicine 10:67-70, 1984.
11. Hess JW, MacDonald RP, Frederick RJ, Jones RN, Neerly J, Gross D. Serum creatine phosphokinase (CPK) activity in disorders of heart and skeletal muscle. Annals of Internai Medicine 61:1015-1020, 1964.
12. Kagen L, Cheidt S, Roberts L, Porter A, Paul H. Myoglobinemia following acute myocardial infarction. American Journal of Medicine 58:177- 182, 1975.
13. Kerr JH, Corbett JL, Prys-Roberts C, Smith AC, Spalding JMK. Involvement of sympathetic nervous system in tetanus. Lancet 2:236-241, 1968.
14. Koskelo P, Kekki M, Wager O. Kinetic behavior of 1311-labelled myoglobin in human beings. Clinical Chemical Acta 17:339-347, 1967.
15. Raman GV, Lee HA. Tetanus and renal failure. British Journal Clinical Practice 38:275-277,1984.
16. Schofield F. Selective primary healthy care: Strategies for control of diseases in the developing world. XXIII. Tetanus: apreventable problem. Reviews of Infectious Diseases 8:144-156, 1986.
17. Seedat YK, Omar MAK, Seedat MA, Wesley A, Pather M. Renal failure in tetanus. British Medical Journal 282:360-361, 1981.
18. Stirnemann V, Stirnemann H, Richterich R, Lundsgaard-Hansen. Serum enzyme activities in clinical and experimental tetanus. Enzymologia Biologica et Clinica 8:7-20, 1967.
19. Stone MJ, Willerson JT, Gomez-Sanchez CE, Waterman MR. Radio immunoassay of myoglobin in human serum. Results in patients with acute myocardial infarction. Journal of Clinical Investigation 56:1334-1339, 1975.
20. Tavares W, Saddy JC, Alfradique MEM, Frias LAM. Estudo dos níveis séricos da creatinofosfoquinase e aldolase em pacientes com tétano. Revista do Instituto de Medicina Tropical de São Paulo 16:189-196, 1974.
21. Weinstein L. Tetanus. New England Journal of Medicine 289:1293-1296, 1973.
22. Wesley AG, Pather M. Tetanus in children: an 11 year review. Annals of Tropical Paediatrics 7:32- 37, 1987.

Adress to correspondence:

Dr. Reinaldo Martinelli.

FACP/ Laboratório de Nefrologia - 1117

Hospital Universitário

Prof. Edgard Santos.

Rua João das Botas s/n, Canela

40110-160

Salvador, BA, Brasil.

Publication Dates

Publication in this collection
16 Apr 2013
Date of issue
Mar 1993

History

Accepted
19 Nov 1992
Received
19 Nov 1992

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

[1] 1. Armitage P, Clifford P. Prognosis in tetanus: use of data from therapeutic trials. Journal of Infectious Diseases 138:1-8, 1978.

[2] 2. Barua AR, Ghosh BP. Studies on serum transaminases and creatine-phosphokinase in tetanus. Journal Indian Medical Association 49:376-380, 1968.

[3] 3. Brezis M, Rosen S, Epstein FH. Acute renal failure. In: BrennerBM, RectorJrFC (eds) Thekidney, 4th edition, WB Saunders Companhy, Philadelphia p. 993-1062, 1991.

[4] 4. Cains JA, Missirlis E, Walker WHC. Usefulness of serial determination of my oglobin and creatinekinase in serum compared for the assessment of acute myocardial infarction. Clinical Chemistry 29:469- 473, 1983.

[5] 5. Choo-Kang E, Hanna W. Serum enzymes changes in tetanus. West Indian Medical Journal 29:191- 197, 1980.

[6] 6. Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications and mortality in 100 cases. British Medical Journal 1:1401-1404, 1979.

[7] 7. Gamier MJ, Marshall FN, Davison KJ, Lepreau Jr FJ. Tetanus in Haiti. Lancet 1:383-386, 1976.

[8] 8. Ghanem MH, Khadr AA, Sharabeen MK, Guirgis FK. The skeletal muscle in tetanus. Journal of Tropical Medicine and Hygiene 76:239-242, 1973.

[9] 9. Griffin JW. Local tetanus. Johns Hopkins Medical Journal 149:84-88, 1981.

[10] 10. Hariparsad D, Pather M, Rocke DA, Wesley AG. Renal function in tetanus. Intensive Care Medicine 10:67-70, 1984.

[11] 11. Hess JW, MacDonald RP, Frederick RJ, Jones RN, Neerly J, Gross D. Serum creatine phosphokinase (CPK) activity in disorders of heart and skeletal muscle. Annals of Internai Medicine 61:1015-1020, 1964.

[12] 12. Kagen L, Cheidt S, Roberts L, Porter A, Paul H. Myoglobinemia following acute myocardial infarction. American Journal of Medicine 58:177- 182, 1975.

[13] 13. Kerr JH, Corbett JL, Prys-Roberts C, Smith AC, Spalding JMK. Involvement of sympathetic nervous system in tetanus. Lancet 2:236-241, 1968.

[14] 14. Koskelo P, Kekki M, Wager O. Kinetic behavior of 1311-labelled myoglobin in human beings. Clinical Chemical Acta 17:339-347, 1967.

[15] 15. Raman GV, Lee HA. Tetanus and renal failure. British Journal Clinical Practice 38:275-277,1984.

[16] 16. Schofield F. Selective primary healthy care: Strategies for control of diseases in the developing world. XXIII. Tetanus: apreventable problem. Reviews of Infectious Diseases 8:144-156, 1986.

[17] 17. Seedat YK, Omar MAK, Seedat MA, Wesley A, Pather M. Renal failure in tetanus. British Medical Journal 282:360-361, 1981.

[18] 18. Stirnemann V, Stirnemann H, Richterich R, Lundsgaard-Hansen. Serum enzyme activities in clinical and experimental tetanus. Enzymologia Biologica et Clinica 8:7-20, 1967.

[19] 19. Stone MJ, Willerson JT, Gomez-Sanchez CE, Waterman MR. Radio immunoassay of myoglobin in human serum. Results in patients with acute myocardial infarction. Journal of Clinical Investigation 56:1334-1339, 1975.

[20] 20. Tavares W, Saddy JC, Alfradique MEM, Frias LAM. Estudo dos níveis séricos da creatinofosfoquinase e aldolase em pacientes com tétano. Revista do Instituto de Medicina Tropical de São Paulo 16:189-196, 1974.

[21] 21. Weinstein L. Tetanus. New England Journal of Medicine 289:1293-1296, 1973.

[22] 22. Wesley AG, Pather M. Tetanus in children: an 11 year review. Annals of Tropical Paediatrics 7:32- 37, 1987.