Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report.
OBJECTIVE
To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum.


METHODS
The intensive care unit of a university teaching hospital.


METHODS
A patient with serotonin syndrome complicated by severe rhabodomyolysis and oliguric acute renal failure.


METHODS
Initially continuous veno-venous hemofiltration was performed at 2 l/hour ultrafiltration (UF) with a standard polysulphone 1.4 m2 membrane (cutoff point, 20 kDa), followed by continuous veno-venous hemofiltration with a SHF membrane (cutoff point, 100 kDa) at 2 l/hour UF, then at 3 l/hour UF and then at 4 l/hour UF, in an attempt to clear myoglobin.


RESULTS
The myoglobin concentration in the ultrafiltrate at 2 l/hour exchange was at least five times greater with the SHF membrane than with the conventional membrane (>100,000 microg/l versus 23,003 microg/l). The sieving coefficients with the SHF membrane at 3 l/hour UF and 4 l/hour UF were 72.2% and 68.8%, respectively. The amount of myoglobin removed with the conventional membrane was 1.1 g/day compared with 4.4-5.1 g/day for the SHF membrane. The SHF membrane achieved a clearance of up to 56.4 l/day, and achieved a reduction in serum myoglobin concentration from >100,000 microg/l to 16,542 microg/l in 48 hours.


CONCLUSIONS
SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure.
Naka
Toshio
T
Department of Intensive Care, Melbourne University, Austin Hospital, Melbourne, Australia.
Jones
Daryl
D
Baldwin
Ian
I
Fealy
Nigel
N
Bates
Samantha
S
Goehl
Hermann
H
Morgera
Stanislao
S
Neumayer
Hans H
HH
Bellomo
Rinaldo
R
D058186:Acute Kidney Injury / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D009212:Myoglobinuria / Q000628:therapy*; D009846:Oliguria / Q000150:complications; D012206:Rhabdomyolysis / Q000628:therapy*; D020230:Serotonin Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors
D009211:Myoglobin