410例急性肾衰竭患者临床特点及影响预后的危险因素分析

目的：总结急性肾衰竭（ARF）的病因、临床特点以及影响预后的因素。方法：回顾性分析收治的410例ARF患者的临床资料及病因、病史与血常规、尿常规、肾功能、电解质、血蛋白、血气分析等影响预后因素。结果：410例ARF患者中,男275例,女135例。男∶女=2.04∶1,平均年龄（48.15±18.33）岁。ARF病因：少年组以急性肾小球肾炎等肾实质性疾病为主,中年组为急性肾衰竭发病年龄高峰,以梗阻性肾病为主,其次为肾实质性病和肝胆胰疾病。老年组病因主要见于肾病,治愈率最低（26.83%）,病死率最高（13.82%）,明显高于青年组（10.92%）和中年组（4.83%）,差异有统计学意义。单因素分析显示有无肾病史、MODS、血K^＋、Hb、HCT、Alb共6个因素是影响预后的因素。多因素Logistic回归分析显示,低血红蛋白、MODS、高血钾是影响病死率的危险因素。结论：肾后性原因导致的ARF需要引起关注。积极治疗原发病因,同时重视增加病死率危险因素纠正,尤其是MODS有助于降低ARF病死率。     

急性肾衰竭伴多脏器功能障碍综合征临床特征分析

目的：了解急性肾衰竭（ARF）伴多脏器功能障碍综合征（MODS）发病情况及临床特征。方法：对2003年1月~2007年12月间住院的ARF患者进行回顾性分析。结果：伴MODS的ARF多见于老年,发病率占总ARF的62.3%,病死率45.5%;随着功能障碍脏器数量的增多,ARF病死率明显升高。引起伴MODS的ARF的原因中以感染性疾病、休克、严重创伤、外科大手术后（以胆道疾病、恶性肿瘤手术）多见。结论：MODS是影响疾病预后的重要因素,伴MODS的ARF多见于老年且发生比例高,病死率亦高,对于伴MODS的ARF患者应进行早期预防性及充分透析治疗,以改善ARF的预后。     

老年人急性肾衰竭61例临床分析

目的:观察老年人急性肾衰竭(ARF)的病因、临床转归及预后.方法:回顾性分析老年人ARF 61例的临床特点.结果:老年人ARF肾前性因素占62.2%,其中脱水电解质紊乱占34.4%,血压控制不佳占18.0%;肾性因素占24.6%,其中ATN为22.9%(包括肾毒性药物如丁胺卡那,尿酸性肾损害各占21.4%,感染、甘露醇性肾损害各占14.2%,其余为抗癌药如顺铂等),肾小血管炎肾损害占3.3%;肾后性因素(前列腺增生症、神经性膀胱)占13.2%.合并多器官功能衰竭(MODS)4例,占7.4%,均死亡.结论:老年ARF病因仍以肾前性因素为主,及时纠正脱水、调控好血压,是防治老年人ARF的关键;老年人ARF肾性因素除传统肾毒性药物致肾损伤外,尿酸性及小血管炎性肾损害因素不容忽视;老年人ARF伴系统性疾病和合并症多,预防和治疗MODS是降低死亡率的重要环节.     

云南地区116例急性肾功能衰竭的临床分析

目的 探讨急性肾功能衰竭(Acute renal failure ARF)的发病情况、病因及死亡原因,以提高急性肾衰竭(ARF)的诊治水平.方法 回顾性分析116例ARF的临床资料,探讨其发病情况、病因与预后关系等.方法 116例ARF病例,肾前性、肾性、肾后性ARF分别占50.00%、39.66%、10.34%.死亡6例,总病死率为5.17%,其中肾前性因素所致ARF病死率占66.67%,明显高于肾性、肾后性因素所致ARF(p<0.05).结论 引起ARF的病因以肾前性因素为主,肾前性ARF病死率最高,积极治疗原发病的同时,若明确ARF病因和死亡原因,早期充分血液净化、对症支持治疗可改善ARF预后,降低病死率.     

320例急性肾功能衰竭患者的临床分析

目的 探讨急性肾功能衰竭（ARF）住院患者的病因、预后及影响预后的因素。 方法 回顾性研究我院2003年12月至2006年12月期间急性肾功能衰竭患者的临床资料。 结果 观察期间住院患者共108 744例次，其中ARF患者320例，老年ARF患者135例，占42.2%。ARF主要病因为感染、心力衰竭和药物。ARF患者总体病死率为31.9%，老年人病死率较高。Logistic回归分析显示心力衰竭、呼吸衰竭及恶性肿瘤是与预后相关的危险因素。接受肾替代治疗组患者病死率低于保守治疗组（23.2％比35.6％，P < 0.05）。 结论 住院患者中ARF的发生率、病死率高，替代治疗组预后较好。     

医院获得性急性肾衰竭的临床分析

目的：探讨医院获得性急性肾衰竭（hospital-acquired acute renal failure,HA-ARF）在流行病学、病因学和预后等方面的临床特点.方法：搜集近10年来住院患者HA-ARF的临床资料,分析其病因、病死率及预后;并与同期社区获得性急性肾衰竭（community-acquired acute renal failure,CA-ARF）患者的临床资料进行比较.结果：76例HA-ARF中57.2%是外科系统患者,其中药物相关性ARF占47.3%,手术相关性ARF占28.9%,感染相关性ARF占23.7%,合并多器官功能障碍综合征（MODS）占21.1%,HA-ARF病死率55.3%,年龄、ICU患者、机械通气、少尿、MODS与预后相关.结论：HA-ARF主要病因是药物、手术、感染,预后差,病死率高.     

275例急性肾损伤的临床资料及预后分析

目的 分析急性肾损伤（acute kidney injury,AKI）的病因,探讨影响其预后的危险因素,为临床更好的认识和预防AKI、改善预后提供依据.方法 回顾性分析275例AKI患者的一般资料、病因、临床特点、实验室检查及治疗情况,分析其与预后的关系.结果 纳入本研究的AKI患者275例,男181例,女94例,中位年龄为57岁,其中青年组（≤40岁）54例（占 19.6%）,中年组（40～60岁）97例（占 35.3%）,老年组（≥61岁）124例（占 45.1%）.275例患者的AKI分期中1期88例（占32%）,2期83例（占 30.2%）,3期104例（占 37.8%）.肾前性病因最常见,153例（占 55.6%）,其中感染相关性疾病最多,其次为心脑血管疾病.肾性病因中以药物性因素最多,其次为肿瘤相关性肾病.肾后性因素以尿路结石最常见,其次为肿瘤转移或浸润.多因素非条件Logistic回归分析示机械通气、血管活性药物、多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）、低蛋白血症是AKI患者死亡的独立危险因素,OR值分别为 2.445、43.530、2.801和3.118（均P＜0.01）.结论 AKI患者中,感染、心脑血管疾病等肾前性病因引起的AKI较常见,要及早诊断并积极干预.机械通气、血管活性药物、MODS、低蛋白血症是AKI患者死亡的独立危险因素.     

116例急性肾衰竭病因和预后分析

目的总结我院收治的急性肾衰竭（ARF）患者的临床特点。方法回顾性分析。结果ARF116例，年龄5～91岁，平均（64．5±19）岁；65岁以上占55．2％；80岁以上占20．7％。病因：肾前性32例（27．6％）；梗阻性肾病26例（22．4％）；多脏器功能不全12例；药物肾毒性10例；急性间质性肾炎4例；造影剂肾病5例；肾炎8例；严重感染9例；横纹肌溶解3例；尿酸性肾病和酒精中毒各1例；5例原因不明。合并感染者42例（36．2％）；肿瘤患者25例（21．6％）。预后：死亡40例，占34．5％；痊愈42例，占36．2％；好转23例，占19．8％；维持性透析4例；转院3例。结论ARF是住院患者常见并发症；尽早解除梗阻是治疗肾后性ARF的最佳选择。     

急性肾衰竭90例临床分析

目的探讨急性肾衰竭（ARF）的病因、临床特点及影响预后的因素。方法回顾分析2002年1月至2006年9月在我院住院的急性肾衰竭患者。结果90例患者中男53例，女37例，平均年龄（46．08±16．33）岁。肾前性29例，主要为手术后低血容量、感染；肾性41例，主要为肾小球疾病及药物所致；肾后性20例，主要为梗阻性。90例中5例死亡，32例痊愈，16例需透析治疗，37例好转。年龄、器官衰竭数、ATN-ISI评分是影响预后的因素。结论肾小球疾病所致的ARF应尽早行肾穿刺检查；术后低血容量所致的ARF伴有多器官功能不全综合征（MODS）时预后欠佳。     

86例急性肾衰竭患者双肾彩色多普勒超声表现分析

目的：探讨急性肾衰竭（acute renal failure,ARF）彩色多普勒超声表现,为进一步的临床诊治提供依据。方法：回顾性分析我院收治的86例 ARF 患者,临床根据病因不同,将 ARF 分为肾前性、肾性及肾后性三组,其中肾前性组51例,肾性组27例（其中不包括慢性肾脏病基础上的 ARF,后文亦同）,肾后性组8例。肾前性组及肾性组 ARF 患者积极给予对症治疗,病情未缓解者,给予血液透析治疗;肾后性组患者在解除梗阻后,病情未缓解者,给予血液透析治疗。采用超声检查,观测其平均肾脏长度、平均肾脏体积及肾脏血流灌注情况,测量血流搏动指数、阻力指数等。结果：肾性组与肾前性组及肾后性组其 Scr 及 BUN 分别比较,P ﹤0．05;肾性组与肾前性组及肾后性组分别比较,其平均肾脏长度差异无统计学意义;肾性组与肾前性组平均肾脏体积比较,P ﹤0．05;而肾性组与肾后性组比较,P ﹥0．05。彩色多普勒超声显示：肾前性及肾性ARF 超声表现为肾脏体积增大,实质增厚,回声增强,肾锥体肿胀,回声增强。肾后性 ARF 超声表现为：双肾增大伴中、重度积水,肾实质变薄,肾锥体消失或基本消失。结论：不同病因的 ARF 其超声影像有其相应的特征性变化,早期识别有助于临床的进一步诊治。     

Role of creatine phosphokinase in predicting acute renal failure in hypocalcemic exertional heat stroke.

Recruits frequently develop hypocalcemia in exertional heat stroke (ExHS) with rhabdomyolysis and acute renal failure (ARF) from intensive training. It usually indicated severe skeletal muscle damage. However, the relative risk of ARF in ExHS patients complicated with hypocalcemia was unknown. The present study was undertaken to evaluate the value of peak serum creatine phosphokinase (CPK) level in predicting ARF in ExHS patients with hypocalcemia. Sixty-eight army recruits with ExHS were hospitalized at the Tri-Service General Hospital, Taiwan: 17 with ARF and hypocalcemia (group A); 7 with ARF but without hypocalcemia (group B); 20 without ARF but with hypocalcemia (group C); and 24 without ARF or hypocalcemia (group D). In the 24 patients with ARF (groups A and B) the serum phosphate and peak CPK levels were significantly higher than in patients without ARF (groups C and D; p < 0.001), serum calcium levels were also significantly lower in the former (p < 0.001). In the 37 patients with hypocalcemia (groups A and C), the peak serum CPK levels were significantly higher than in those without hypocalcemia (groups B and D; p < 0.001). There was a higher proportion of hypocalcemic patients with peak serum CPK levels greater than 10,000 U/l among ARF compared with patients without ARF (chi 2 = 12.48, p < 0.001). In 24 patients with ARF, there was a negative correlation between serum Ca and peak CPK levels (t = 3.37, r = -0.58, p < 0.01). However, a positive correlation was found between serum creatinine and peak serum CPK levels in 37 patients with hypocalcemia (t = 2.47, r = 0.39, p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute changes in renal function after laparoscopic gastric surgery for morbid obesity.

BACKGROUND: Acute renal failure (ARF) is a serious complication that contributes to patient morbidity and may result in death. To date, no data are available regarding the predictive risk of ARF or its effect on the outcome of patients who undergo laparoscopic gastric bypass. METHODS: The medical records of 1800 patients who underwent gastric bypass from July 1997 to July 2003 at a single institution were analyzed. The data collected included demographics, comorbid factors, operative details, and postoperative outcomes. Multivariant analysis was performed and the results were compared with those of 500 age-, gender-, and comorbidity-matched control patients who underwent similar operations. RESULTS: The mean age was 50 +/- 8 years; 23 were men and 19 were women. Of the 1800 patients, 42 (2.3%) developed ARF after surgery. Dialysis was required in 6 patients, 2 of whom became dialysis dependent. ARF completely resolved in the remaining patients. CONCLUSION: Primary ARF after laparoscopic gastric bypass is an uncommon complication, with an incidence of 2.3% in our institution. Patients with a body mass index >50, previous chronic renal failure, and long operating times and intraoperative hypotension are at the greatest risk of postoperative renal failure. All patients who had normal renal function preoperatively returned to normal renal function within 6 months.     

Clinical profile and factors affecting mortality in acute renal failure.

The records of 110 patients with acute renal failure (ARF) admitted to the Department of Medicine of the Philippine General Hospital during a 5-year period (1983-1988) were reviewed. The objectives were to evaluate the clinical profile of ARF patients and to determine what factors influenced mortality. Infection significantly influenced the causation and prognosis of ARF. Fifteen patients died, for an overall mortality rate of 14%. Forty-six clinical variables were analyzed in order to identify factors correlated with mortality. Four variables significantly increased the risk of death from ARF: older age, hyperkalemia, oliguria, and presence of sepsis on admission. These characteristics define a subset of patients for whom more aggressive treatment of ARF is warranted.     

术前血浆β2-微球蛋白增高与肝移植术后发生急性肾衰竭的关系

目的探讨β2-微球蛋白（β2-microglobulin,β2-MG）水平与肝移植术后急性肾衰竭（acute renal failure,ARF）发生率的关系。方法研究对象为2004年3月至2006年11月在中山大学附属第三医院由同一手术小组进行下腔静脉全阻断改良背驮式肝移植的80例终末期肝病患者,术前血清肌酐（Scr）、血尿素氮（BUN）检测均在正常范围,术中未采用体外静脉-静脉转流术。术前采用散射比浊法测定两组患者桡动脉血β2-MG值。根据术前血β2-MG值正常与否将患者分为两组：术前血β2-MG值异常组（I组）,术前血β2-MG值正常组（Ⅱ组）。术后按有否发生重度ARF分为重度ARF组和非重度ARF组。全部患者术后进行至少随访3年,以随访结束日或死亡为研究终点。记录并比较Ⅰ组与Ⅱ组患者术后ARF的发生率及术后30d、术后1年、2年及3年的生存率;记录并比较重度ARF组和非重度ARF组术后30d、术后1年、2年及3年的生存率。结果根据术前血β2-MG值分组,Ⅰ组32例,Ⅱ组48例,术前血β2-MG值增高异常率为40％。Ⅰ组32例患者中11例（34％）发生轻度ARF,6例（19％）发生重度ARF;Ⅱ组48例患者中12例（25％）发生轻度ARF,1例（2％）重度ARF。两组的轻度和重度ARF发生率比较差异有统计学意义（均为P〈0．05）。Ⅰ组与Ⅱ组相比较,术后30d及术后1年生存率差异无统计学意义（均为P〉0．05）;术后2年及3年生存率比较差异有统计学意义（均为P〈0．05）。重度ARF组的术后30d、术后1年、2年、3年生存率远低于非重度ARF组患者（均为P〈0．01）。结论肝移植患者术前肾功能异常与术后ARF发生率有关,与Scr比较,血浆β2-MG是反映早期肾损害更灵敏的指标,并且具有预测术后ARF的能力。     

Allopurinol and enalapril failed to conserve urinary NOx and sodium in ischemic acute renal failure in spontaneously hypertensive rats

BACKGROUND: Ischemia-reperfusion-induced acute renal failure (ARF) is associated with a high mortality in patients with hypertension and with an unfavorable outcome of kidney transplants from marginal donors. AIM: The influence of allopurinol and enalapril on urinary nitrate/nitrite (UNOx), glomerular filtration rate, plasma and urinary sodium, and hemodynamic parameters was examined in spontaneously hypertensive rats (SHR) with ARF. METHODS: ARF was induced by right-kidney removal and clamping the left renal artery for 40 min in 50 male 26-week-old SHR weighing 300 +/- 23 g. The rats were randomly allocated to five groups: (1) sham operated; (2) ARF; (3) ARF after pretreatment with 40 mg/kg allopurinol; (4) ARF after pretreatment with 40 mg/kg enalapril, and (5) ARF after pretreatment with 40 mg/kg allopurinol and 40 mg/kg enalapril. Creatinine clearance, UNOx (Griess reaction), cardiac output (dye dilution technique), mean arterial blood pressure, and renal blood flow were measured 24 h after reperfusion. Total vascular resistance and renal vascular resistance were calculated and compared between the groups. RESULTS: A nonsignificant decrease was found in both daily UNOx excretion and creatinine clearance when pretreated ARF groups and the ARF group without pretreatment were compared (p > 0.05). Significantly lower plasma sodium values (139.5 +/- 4.86 mmol/l) in the allopurinol-pretreated ARF group were found than in the ARF group without pretreatment, in the ARF group pretreated with enalapril, and in the sham SHR group (p = 0.029). The urinary sodium loss was greater in the enalapril-pretreated than in the allopurinol-pretreated ARF group (p = 0.047). Allopurinol and/or enalapril pretreatment decreased total vascular resistance (p = 0.003) in comparison with the sham SHR group. CONCLUSION: Neither allopurinol nor enalapril nor both were protective against ischemia-reperfusion injury in SHR, nor altered glomerular filtration rate and UNOx in a favorable direction.     

Twelve years experience of acute renal failure in Taiwan

Summary: A retrospective analysis of the records of 287 patients diagnosed with acute renal failure (ARF) who were admitted between 1 January 1983 and 30 November 1994 to the emergency Service Department of the National Taiwan University Hospital, Taiwan was conducted. A total of 176 men (61.3%) and 111 women (38.7%) were surveyed. the classification of ARF by year revealed a progressive increase in case numbers. the majority (57.5%) of the patients were elderly, particularly in the years 1987-88 and 1993-94, the differences (aged compared with the young) being statistically significant. There were 176 patients (61.3%) in the pre-renal group (with evident intravascular volume depletion, haemodynamic instability or sepsis, with a urine excretion of sodium (FE_Na<1%), 43 (15%) in the renal group (urine analysis revealing protenuria, granular casts or/and tubular epithelial casts and without response to treatment of volume repletion), and 27 (9.4%) in the postrenal group (diagnosed when there were supporting image studies). Overall mortality was 63% and the pre-renal ARF patients had the poorest survival rate (25.6%). the classification of mortality rates by diagnostic category and year revealed a persistently high mortality rate. We conclude that: there are increasing patients with ARF each year; aged patients comprise the majority of cases; and the mortality rate remains high because of the high mortality rate of the pre-renal group, which was due to the presence of complicating underlying diseases and concomitant organ failure. the effects of having an ageing population were also apparent.     

Risk factors for development of acute renal failure after liver transplantation

BACKGROUND: Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX. METHODS: Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx. ARF was defined as serum creatinine > or = 2.0 mg/dL in the first 30 days after LTx. Univariate and multivariate analysis by logistic regression were performed. RESULTS: ARF group comprised 56 patients (61%). Preoperative serum creatinine was higher in ARF group. During the intraoperative period, ARF group required more blood transfusions, developed more episodes of hypotension and presented longer anesthesia time. In the postoperative period, ARF group presented higher serum bilirubin and more episodes of hypotension. Dialysis was required in 10 patients (11%). The identifled risk factors for development of ARF were: preoperative serum creatinine > 1.0 mg/dL. more than five blood transfusions in the intraoperative period, hypotension during intra and postoperative periods. The identified mortality risk factors were hypotension in the postoperative period and no recovery of renal function after 30 days. CONCLUSIONS: Several factors are involved in the pathogenesis of ARF after LTx and may influence patients outcome and mortality. Pretransplant renal function and hemodynamic conditions in the operative and postoperative periods were identified as risk factors for development of ARF after LTx. Nonrenal function recovery and postoperative hypotension were identified as mortality risk factors after LTx.     

Predictive factors for acute renal failure in crush injuries in the Sichuan earthquake

IntroductionThe Sichuan earthquake caused a large number of crush injuries and many of them developed acute renal failure (ARF). A retrospective study was performed on victims with crush injuries of West China Hospital to investigate the predictive factors for acute renal failure (ARF) in crush injuries.Patients and methodsMedical records of injured victims treated in West China Hospital within the first week after the Sichuan earthquake were retrospectively reviewed and 101 patients with crush injury were enrolled in the study. We divided them into an ARF group and a non-ARF group. The clinical data of included patients were extracted and analysed.ResultsPatients with ARF accounted for 42% of the included population. Patients younger than 20 made up the biggest age category (45%), and the entrapped time under the debris (22 [IQR 3.5–38] h) was longer than previous reports. In univariate analysis, male gender, multiple crush injuries, medical comorbidities, surgical interventions and infections were more frequent in patients with ARF than in those without ARF. Mean arterial pressure was higher in the ARF group. Besides, the risk of ARF was increased by creatine kinase >14,494.5 IU/L most significantly, followed by time under the rubble >4 h, aspartate transaminase >453.5 IU/L, albumin <27.15 g/L and white blood cell >11.8 × 10⁹/L. In multivariate analysis, male gender, time under the rubble, multiple crush injuries, surgical interventions, infections and creatine kinase level were independently associated with ARF in crush injuries.ConclusionsThe entrapped time under the debris, multiple crush injuries, male gender, infections, and creatine kinase level are predictive factors for ARF in crush injuries.     

Acute spontaneous tumor lysis presenting with hyperuricemic acute renal failure: clinical features and therapeutic approach

BACKGROUND: Acute spontaneous tumor lysis syndrome (STLS) presenting with hyperuricemic acute renal failure (ARF) is a rare disease which can be overlooked in patients with neoplasic disorders, requiring prompt recognition and aggressive management. This study examined the incidence, clinical characteristics and prognosis of this condition. METHODS: A retrospective study was performed, reviewing the records of all patients who developed ARF at Chang Gung Memorial Hospital between 1st July 1999 and 30th October 2002. Acute STLS was diagnosed based on pretreatment hyperuricemic ARF, ratio of urinary uric acid to creatinine (Cr) >1.0, and significantly elevated lactate dehydrogenase (LDH) (>500 units/L), together with a pathologically proven malignancy. Clinical course, metabolic parameters, response to therapeutics and outcome were assessed in all patients. RESULTS: STLS-induced acute uric acid nephropathy was identified in 10 out of 926 ARF patients (1.08%) studied. Most presentations were non-specific or related to malignancy symptoms. All patients had advanced tumors with large tumor burden, and abdominal organ involvement in 80% of patients. The 10 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (mean +/- SD: 20.7 +/- 5.0 mg/dL) until dialysis initiation. Seven patients (70%) developed diuresis, with an associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. The patients who developed diuresis had mean serum uric acid levels 9.3 +/- 3.1 mg/dL and median levels 9.8 mg/dL. Three patients (30%) survived, with two patients suffering residual renal function impairment. CONCLUSIONS: Acute STLS presenting with hyperuricemic ARF is a rare cause of acute uric acid nephropathy in patients with bulky or occult neoplastic disorders. The tumors that developed STLS had advanced stage or large tumor burden. Frequent abdominal organ involvement and non-specific initial presentations can obscure the nature of the disease and delay diagnosis. Unlike hyperuricemia and oliguria, which are constant findings, azotemia or impaired renal function is not always manifest on initial presentation. Poor outcomes in patients with STLS developing acute uric acid nephropathy make early recognition, aggressive management and prompt dialysis mandatory.     

Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis

BACKGROUND: (I) To investigate the kinetics of the myoglobin and creatine kinase (CK) in rhabdomyolysis. Especially to describe those patients in whom an isolated increase in the myoglobin or the CK occurred at a later stage. (II) To evaluate the sensitivity of the myoglobin and the CK as prognostic tools for the development of Acute renal failure (ARF). (III) To investigate the effect of continuous venovenous haemodiafiltration (CVVHDF) on the myoglobin elimination in ARF. PATIENTS AND METHODS: Prospective and retrospective cohort study carried out in an ICU of a university hospital. A total of 47 critically ill patients with rhabdomyolysis and a plasma myoglobin > 5000 microg l(-1) were admitted between July 1998 and July 2003. RESULTS: (I) The myoglobin peaked 0.66 +/- 0.6 days before the CK. The elimination kinetics of the myoglobin was faster than for the CK. (II) Fifty percent developed ARF. Mortality in the ARF patients was 52% compared to 14% in the non-ARF patients. The sensitivity and specificity of developing ARF were higher with the myoglobin in comparison to the CK. (III) In non-ARF, t(1/2) CK was 25.5 h and t(1/2) myoglobin was 17 h (13-23). In those with ARF treated with CVVHDF, t(1/2) CK was 24.8 and t(1/2) myoglobin was 21 h (17-29). CONCLUSION: (I) The myoglobin peaked earlier than the CK. (II) The myoglobin was a better prognostic tool than the CK. However, the myoglobin also has a wide interindividual range. (III) Though the myoglobin is eliminated in ultrafiltration t(1/2) myoglobin, it was not faster in patients with ARF treated with CVVHDF compared to non-ARF patients.