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Colegio de Medicina Interna de México.

2007, Número 1

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Med Int Mex 2007; 23 (1)


Rabdomiólisis e insuficiencia renal aguda

Duarte MJ, Díaz MS, Lee ECVE

Idioma: Español
Referencias bibliográficas: 53
Paginas: 47-58
Archivo PDF: 207.95 Kb.


RESUMEN

La rabdomiólisis es la liberación de componentes de músculo lesionado a la circulación, y sus causas son muchas. La compresión directa de un grupo muscular conduce a lesión por aplastamiento, con isquemia muscular si la tensión del tejido se eleva y excede la de perfusión capilar, lo que constituye el mecanismo principal de la rabdomiólisis traumática. Una vez liberada la compresión, el tejido afectado se reperfunde. La isquemia muscular seguida de reperfusión (lesión–isquemia–reperfusión) representa su mecanismo fisiopatológico. La intoxicación aguda por alcohol, con la consiguiente inmovilidad y coma, es el factor etiológico más común de compresión muscular directa. Otras causas son de tipo infeccioso, metabólico y genético. La emisión de orina oscura, positiva en las tiras reactivas para sangre a pesar de la ausencia de eritrocitos en el microscopio, sugiere mioglobinuria y rabdomiólisis. La prueba diagnóstica más rápida y económica es la concentración sérica de la creatina-cinasa (CK). La insuficiencia renal aguda es una de las complicaciones más graves de este padecimiento y ocurre en 4 a 33% de los casos, con mortalidad de 3 a 50%. La resucitación vigorosa con líquidos es la piedra angular del tratamiento.


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