Successful management of critical illness polyneuropathy and myopathy in renal transplant recipients.
Critical illness polyneuropathy and myopathy commonly occur in patients with multiorgan failure and sepsis. Distal muscle weakness and loss of deep tendon reflexes are usually found, with sparing of the cranial nerve musculature. Many risk factors have been identified, specifically hypoxia, hypotension, hyperpyrexia, and age. Other independent risk factors include female sex, severity of illness, duration of organ dysfunction, renal failure and renal replacement therapy, hyperosmolality, parenteral nutrition, low serum albumin level, duration of intensive care unit stay, vasopressor and catecholamine support, and central neurologic failure. Hyperglycemia also has been identified as an independent risk factor, with important potential affect in terms of prevention. Herein, we report the development of critical illness polyneuropathy and myopathy in 7 of 22 renal transplant recipients who underwent successful ventilator weaning during treatment for bronchopneumonia. This is the first report of critical illness polyneuropathy and myopathy among renal transplant recipients. Clinical suspicion and electrophysiologic studies are tools for early diagnosis. Proper management, including correction of risk factors (especially diabetes) and long-term rehabilitation measures might be beneficial.
Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait. gheith@yahoo.com
Osama
O
Gheith
Torki
T
Al Otaibi
Medhat
M
Halim
Medhat
M
Abdelhalim
Tarek
T
Said
Prasad
P
Nair
Mohamed
M
Balaha
Khalid
K
Abd-el-Tawab
Zakareya
Z
Zakareya
Waleed
W
Hosni
M R Narayanan
MR
Nampoory
D000328:Adult; D000368:Aged; D001996:Bronchopneumonia / Q000628:therapy; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D010346:Patient Care Management; D011115:Polyneuropathies / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D014180:Transplantation; D012122:Ventilators, Mechanical