Continuous Renal Replacement Therapy Management in a Patient with Severe Traumatic Brain Injury and Rhabdomyolysis-Associated Acute Kidney Injury

Abstract

Acute kidney injury (AKI) has been considered a rare complication in traumatic brain injury (TBI) patients, with the majority of cases occurring in the setting of multiple-organ trauma with muscle injury or multiple-organ failure. Post-traumatic rhabdomyolysis is a relatively rare cause of AKI and a potentially life-threatening condition defined as crush syndrome. In a TBI patient with rhabdomyolysis-associated AKI, reducing renal injury from myoglobin and other nephrotoxins may be crucial to increase the probability of survival. Despite the accepted use of continuous renal replacement therapy (CRRT) in patients with TBI and co-existing AKI, there is still limited data on safety and no data regarding timing and optimal modality. Particularly, there is controversy concerning the advantages of hemofiltration versus hemodialysis over the other in the setting of AKI. For this reason, the use of CRRT for rhabdomyolysis-associated AKI in severe trauma patients with severe TBI could be really challenging. We report a therapeutic approach in a trauma patient with severe TBI for extracorporeal removal of myoglobin in rhabdomyolysis-associated AKI, exploring trends in cerebral hemodynamics, solute concentrations, and osmolarity.