Prevention and treatment of heme pigment-induced acute kidney injury (acute renal failure)
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
Acute kidney injury (AKI) can occur in patients who have rhabdomyolysis and, less commonly, in patients with hemolysis [1,2]. In both groups of patients, AKI is caused by the nonprotein heme pigment that is released from either myoglobin or hemoglobin and is toxic to the kidney.
The prevention and treatment of heme pigment-induced AKI due to nontraumatic rhabdomyolysis or hemolysis will be reviewed here. The clinical features and diagnosis of this disorder, AKI due to traumatic muscle injury, overviews of rhabdomyolysis and hemolysis, and the general management of oliguric acute renal failure (ARF) and its complications are discussed elsewhere. (See "Clinical features and diagnosis of heme pigment-induced acute kidney injury (acute renal failure)" and "Crush-related acute kidney injury (acute renal failure)" and "Clinical manifestations and diagnosis of rhabdomyolysis" and "Diagnosis of hemolytic anemia in the adult" and "Dialysis-related factors that may influence recovery of renal function in acute kidney injury (acute renal failure)".)
In addition to treating the underlying rhabdomyolysis or hemolysis, the general goals for preventive therapy in all patients at risk for heme pigment-induced AKI are twofold:
●Correction of volume depletion if present
●Prevention of intratubular cast formation
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