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Rhabdomyolysis: pathogenesis of renal injury and management

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Acknowledgements

MZ receives funding from the Fondation de Recherche en Santé du Québec, the Kidney Research Scientist Core Education and National Training Program, and the McGill University Health Centre Research Institute.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, QC, Canada, H3H 1P3

    Zubaida Al-Ismaili, Melissa Piccioni & Michael Zappitelli

Authors
  1. Zubaida Al-Ismaili
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  2. Melissa Piccioni
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  3. Michael Zappitelli
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Corresponding author

Correspondence to Michael Zappitelli.

Additional information

Answers:

1. b

2. b

3. b

4. b

5. c

Multiple choice questions (answers appear following the reference list)

Multiple choice questions (answers appear following the reference list)

  1. 1.

    The most common cause of sporadic rhabdomyolysis in children is:

    1. a.

      Exercise

    2. b.

      Viral infection with myositis

    3. c.

      Muscular dystrophy

    4. d.

      Metabolic and hereditary disease

  2. 2.

    The following mechanisms are important in rhabdomyolysis-induced acute kidney injury except:

    1. a.

      Volume depletion and renal ischemia

    2. b.

      Direct glomerular injury

    3. c.

      Tubular obstruction

    4. d.

      Tubular toxicity

  3. 3.

    Regarding the management of rhabdomyolysis, all are correct except:

    1. a.

      The rationale behind mannitol infusion is for its roles as an osmotic diuretic, renal vasodilator, and free-radical-scavenging agent

    2. b.

      Fluid therapy should initially be conservative to avoid the risk of fluid overload

    3. c.

      The rationale behind use of urine alkalinization includes free-radical scavenging and preventing tubular cast formation

    4. d.

      Human studies have not convincingly shown that mannitol and urine alkalanization reduces the risk of acute kidney injury

  4. 4.

    The following statement regarding RRT in acute-kidney-injury-induced rhabdomyolysis is correct:

    1. a.

      Continuous venovenous hemodialysis can be used to clear myoglobin

    2. b.

      Continuous venovenous hemofiltration can be used to clear myoglobin

    3. c.

      Continuous venovenous hemofiltration is not useful in treatment of severe hyperkalemia, acidosis, and volume overload

    4. d.

      There is no difference in the type of hemofilter membrane used for myoglobin clearance

  5. 5.

    The following are true about recurrent and genetic causes of rhabdomyolysis except:

    1. a.

      McArdle’s disease is a glycogen storage disease involving mutation of a muscle myophosphorylase

    2. b.

      Hereditary causes of severe hypokalemia may lead to recurrent rhabdomyolysis via increased muscle depolarization

    3. c.

      Fatty-acid-oxidation disorders lead to rhabdomyolysis by causing instability of the myocyte membrane

    4. d.

      The general mechanism of inherited/genetic disorders of carbohydrate metabolism in causing rhabdomyolysis is ATP-depletion-related muscle-cell death

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Al-Ismaili, Z., Piccioni, M. & Zappitelli, M. Rhabdomyolysis: pathogenesis of renal injury and management. Pediatr Nephrol 26, 1781–1788 (2011). https://doi.org/10.1007/s00467-010-1727-3

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