title: High body mass index in muscular patients and flank position are risk factors for rhabdomyolysis: case report after laparoscopic live-donor nephrectomy.
abstract: OBJECTIVE
  Rhabdomyolysis is well known after traumatic crush injuries or ischemia involving muscles. Postoperatively, it most likely is secondary to surgical positioning and patient muscle mass. We report a case after laparoscopic live-donor nephrectomy.
  
  
  METHODS
  A muscular 35-year-old man underwent elective left laparoscopic live-donor nephrectomy in a 70 degrees flank position with four ports. He was in the right-side lying position with hip flexion (flank position) for approximately 4 hours. A kidney bridge had been placed between the iliac crest and the rib cage. Postoperatively, the patient had light-pinkish urine and low urine output. There was marked induration of the buttocks and significant pedal and scrotal edema. With judicious use of alkalinization and diuretics, the patient did not require dialysis, and renal function returned to base level by postoperative day 20. The recipient of the kidney had a normal postoperative course.
  
  
  CONCLUSIONS
  Rhabdomyolysis is a syndrome of muscle necrosis and release of intracellular components into the circulation. Acute renal failure secondary to myoglobinuria is a common complication. We currently use little flexion of the table during donor nephrectomy and bring the table to a neutral position immediately after kidney retrieval. Postoperatively, one needs a high index of suspicion for rhabdomyolysis to avoid or at least promptly recognize this rare but potentially serious condition after any operation lasting >or=4 hours.
authors.affiliation: Department of Urology, SUNY-Stony Brook University Health Sciences Center, School of Medicine, Stony Brook, New York 11794-8093, USA. jarehman@notes.cc.sunysb.edu
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: Joseph
authors.initials: J
authors.lastname: Boglia
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Troy
authors.initials: T
authors.lastname: Sukkarieh
authors.forename: Sardar A
authors.initials: SA
authors.lastname: Khan
authors.forename: Richard
authors.initials: R
authors.lastname: Lewis
authors.forename: Frank
authors.initials: F
authors.lastname: Darras
authors.forename: Nand K
authors.initials: NK
authors.lastname: Wadhwa
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Waltzer
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000328:Adult; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D009212:Myoglobinuria / Q000150:complications / Q000628:therapy; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011187:Posture; D012206:Rhabdomyolysis / Q000150:complications / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors
chemical_list: D003404:Creatinine