Rhabdomyolysis with compartment syndrome-induced acute kidney injury in resource-limited settings: A case report

BACKGROUND: Diagnosis and management of rhabdomyolysis-induced acute kidney injury (AKI) are challenging in resource-limited settings. Laboratory markers for the diagnosis of rhabdomyolysis and continuous renal replacement therapy (CRRT) for the management of unstable hemodynamic AKI may be difficult to access. This report presented a case of rhabdomyolysis with compartment syndrome, which had a high prognostic factor for kidney failure and death in Lombok, Indonesia. CASE PRESENTATION: A 34-year-old man came to the hospital complaining of pain and swelling in his right thigh after being buried by an avalanche of buildings. Laboratory examination showed leukocytosis, hemoconcentration, increased creatinine, metabolic acidosis, hyperkalemia, and dark brown urine. Muscle damage markers showed levels of creatinine phosphokinase >20000 U/L, aspartate aminotransferase 255 U/L, alanine aminotransferase 186 U/L, and lactate dehydrogenase >3000 U/L. Diagnosis of rhabdomyolysis, compartment syndrome, and AKI was primarily on clinical grounds. Despite immediate management (fluid therapy, antibiotics, and fasciotomy), the patient continued progress to AKI. Because CRRT was not available, the patient received a single hemodialysis treatment. A day later, the patient developed hypotension, went into septic shock, and died after five days of treatment. CONCLUSION: A patient with rhabdomyolysis, compartment syndrome, and acute kidney injury could have a better outcome if the patient arrived early and is treated immediately in a fully-equipped health care facility.