Acute tubular necrosis associated with Lowe's syndrome: possible role of rhabdomyolysis.
The oculo-cerebral-renal syndrome of Lowe is an X-linked recessive disorder characterized by severe mental retardation, congenital cataracts, renal tubular dysfunction, growth retardation, hypotonia, glaucoma, and rickets. Recently, it has been found that serum concentrations of the muscle enzymes are elevated, providing evidence that there is primary muscle involvement in this disorder. The renal functional abnormalities that occur have also been further delineated. Renal tubular dysfunction presents within the first year of life, followed by a serum creatinine level that increases with age. Renal failure generally occurs in the fourth decade of life. We report two patients with Lowe's syndrome who presented with new onset of acute renal failure (ARF). Workup of their ARF established the diagnosis of acute tubular necrosis with evidence of rhabdomyolysis in one case. These patients were treated aggressively with dialysis and had subsequent recovery of renal function to their baseline state. We suggest that patients with Lowe's syndrome who present with an acute change in their renal function should be treated early with vigorous hydration therapy. If dialysis is indicated, it should be initiated. Furthermore, these patients should be promptly evaluated for evidence of rhabdomyolysis with alkalinization of the urine if possible.
Fivush
B A
BA
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Racusen
L C
LC
Christenson
M J
MJ
Olson
J L
JL
D001706:Biopsy; D002648:Child; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008854:Microscopy, Electron; D009399:Nephrons / Q000473:pathology / Q000648:ultrastructure; D009800:Oculocerebrorenal Syndrome / Q000150:complications*; D010530:Peritoneal Dialysis; D012206:Rhabdomyolysis / Q000150:complications*