Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance.docVIP

Available online /content/9/2/141 Commentary Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance Claudio Ronco Department of Nephrology, St Bortolo Hospital, Vicenza, Italy Corresponding author: Claudio Ronco, cronco@goldnet.it Published online: 8 February 2005 Critical Care 2005, 9:141-142 (DOI 10.1186/cc3055) This article is online at /content/9/2/141 ? 2005 BioMed Central Ltd See related research by Naka et al. in this issue [/content/9/2/R90], and review, page 158 [/content/9/2/158] Abstract therapies have so far displayed controversial results but in general they have been proved to be modestly useful. Thus, although the rationale for a quick and effective removal of myoglobin in acute rhabdomyolysis would be strong and logical, the practical results obtained with traditional methods have been disappointing. The inefficient removal of myoglobin results in a permanently high circulating level of the molecule Rhabdomyolysis is a pathogenetic cause of acute kidney injury. In such circumstances, not only should therapeutic strategies to replace the failing kidney be implemented, but measures should also be explored to prevent further damage by circulating myoglobin. Volume expansion and forced diuresis have been used, but when a kidney fails, renal replacement therapies are instituted. The techniques and devices used for classic dialytic techniques have displayed a limited capacity for the removal of circulating myoglobin. In a recent paper, Naka and colleagues have proposed the use of a super-high-flux membrane in continuous hemofiltration. The removal of myoglobin was greater than in than any previous Thus, if the removal of myoglobin is desirable, a combination of continuous hemofiltration and hyperpermeable membranes seems to be the most effective. However, care must be exercised to prevent unwanted albumin losses. an