text/Medical popularization writer Zilin
review expert/ Peking University First Hospital Deputy Director of Nephrology Department Chief Physician Zhou Fude
"Crypto" on the blood test sheet
There is a young male patient named Liu Lianfa (pseudonym). He dragged his swollen body and brought a blood test report sheet to the Department of Nephrology Hospital of Peking University alone for treatment.
When you hear it, your whole body will feel that it has a kidney problem. Indeed, Liu Lianfa suffered from nephrotic syndrome a few years ago, but things are far from that simple.
Dr. Zhou Fude, who was treated at that time, also found an important clue from the blood test results: " creatine kinase is elevated"!
If it is just a kidney disease, this index will not be high. High creatine kinase is either myocarditis or a disease called " rhabdomyolysis syndrome ".
. In Liu Lianfa's test results, the specific index of myocardial enzyme "creatine kinase's myocardial isozyme" is not high, which means he has rhabdomyolysis syndrome.
After detailed consultation, Liu Lianfa said that he had driven more than 1,300 kilometers of cars to travel a few days ago. This seemingly inconspicuous sentence made Dr. Zhou Fude even more sure of the diagnosis. In addition to nephrotic syndrome, Liu Lianfa also suffered from rhabdomyolysis syndrome.
What is rhabdomyolysis syndrome? What does it have to do with driving a long-distance bus? Do you feel confused?
Strapezoidal Dissolving Syndrome What is the "ghost"?
The muscles of the human body include myocardium, smooth muscle, skeletal muscle . Smooth muscles are mainly distributed in the intestine and blood vessel walls, while striated muscles are distributed throughout the body, mainly referring to the muscles responsible for movement next to the bones of the whole body, also known as skeletal muscles. The reason why
has the name "straight flesh on the face" is because it has "a face full of horizontal lines" and the surface is covered with horizontal lines (as shown below).
Then what's going on with rhabdomyolysis of this ? Dr. Zhou Fude said that there was no myoglobin in our blood, and these myoglobins are usually kept in our striated muscles honestly.
The reason why Liu Lianfa has so much myoglobin appears in his blood is precisely because some factors, such as trauma, caused damage to the striated muscle, which made these myoglobins "scared away".
Therefore, rhabdomyolysis is not the muscle dissolving , but the cells in the muscle have dissolved.
The symptoms that often occur at this time are dark urine color, redness, less urine, muscle pain, etc.
If you go to the hospital for examination, if the urine occult blood is positive, rhabdomyolysis syndrome needs to be suspected. If the test is found that serum myoglobin is increased or creatine kinase is increased more than 5 times the upper limit of the normal value, and heart disease is ruled out, rhabdomyolysis syndrome can be diagnosed.
However, the harm of rhabdomyolysis syndrome is not just these symptoms. Because myoglobin is filtered through the kidneys, it is large, but renal tubules are very thin, so it will directly damage the renal tubules or form a tubular blockage, block the renal tubules, causing renal tubules to damage or even renal failure.
And after muscle damage, large amounts of potassium in the cells are released in the blood, which will also lead to an increase in blood potassium and cause arrhythmia.
Therefore, rhabdomyolysis syndrome is not as simple as a muscle cell disappearing and dissolving. In severe cases, it will be life-threatening.
Why does striatalis dissolve?
Dr. Zhou Fude said that rhabdomyolysis syndrome also has another name, called extrusion syndrome . As the name suggests, it is muscle dissolution caused by trauma.
The origin of the name "squeezing syndrome" was first seen in people who were buried under the ruins after an earthquake. Once the body is squeezed or other trauma, the muscles will release a large amount of myoglobin and run into the blood.
is also the reason. Only the striated muscle is prone to dissolution because it grows externally and has many chances of injury.Both the smooth muscle and myocardium grow in the internal organs, and there is little chance of injury and dissolution.
But later, patients with rhabdomyolysis syndrome who have no compression trauma will always be found in clinical practice. For example, Liu Lianfa is caused by driving a long-distance bus, medically divided the pathogenic factors of this type of disease into traumatic and non-traumatic.
Why does driving cause rhabdomyolysis?
Strong exercise can cause rhabdomyolysis, which is also the main reason for rhabdomyolysis. Many people have heard of this. Dr. Zhou Fude said that if a person does not exercise normally and suddenly runs 400 meters, rhabdomyolysis syndrome may occur.
Researchers have conducted relevant tests. Among the people who run marathons, about 50% of people have had muscle damage, but muscle damage is not necessarily all of them have symptoms. This is why it is often said that exercise should be progressive step by step and not too vigorously at once. The same is true for driving a long-distance bus. If you sit for a long time, your buttocks will be damaged after being compressed for a long time. Including hard-pressing the steering wheel, the upper arm muscles will be damaged over time, resulting in rhabdomyolysis.
lipid-lowering drugs may also cause rhabdomyolysis!
Dr. Zhou Fude has seen patients with high serum creatinine (representing an indicator of renal function damage) in the outpatient clinic, but cannot find out the specific cause. Later, through detailed consultation, it was found that taking statins lowering lipid drugs was the cause. There is a statistics for
. The incidence of rhabdomyolysis caused by taking statins alone is 0.1%-0.5%, and the incidence of combined medications increases to 0.5%-2.5%. After stopping the lipid-lowering medicine, it will return to normal.
Because statins have such side effects, we would like to remind patients who use this type of drug to take the medicine as prescribed by the doctor. You should not be too willful when taking the medicine.
Hypothyroidism may also cause rhabdomyolysis!
Dr. Zhou Fude has also seen taking amiodarone due to the treatment of arrhythmia, causing general edema, muscle pain and increased serum creatinine.
The reason why blood creatinine is increased and muscle pain is because of myolysis. Because one of the side effects of the drug amiodarone is that it will damage the thyroid gland and lead to hypothyroidism.
This disease of hypothyroidism itself can lead to myolysis and renal failure. Dr. Zhou Fude said that among patients with hypothyroidism, about 90% of people have increased creatine kinase.
In addition, epilepsy seizures, burns, high-voltage electric shock, and general body spasms can all lead to rhabdomyolysis.
Can rhabdomyolysis be cured? Why did you find out earlier?
Rhabdomyolysis syndrome is dangerous, but as long as the treatment is timely, most of them can be cured.
Zhou Fude reminds: If you have the above factors that can cause rhabdomyolysis, once you find that the color of the urine becomes darker, redder, less urine, and muscle pain, you should suspect that it is rhabdomyolysis and you should go to the hospital's nephrology department for testing immediately. Creatine kinase is the most sensitive indicator of muscle damage. The higher it is, the more serious the muscle damage is.
If it is asymptomatic rhabdomyolysis, it can generally heal itself without treatment. Drinking more water can help myoglobin metabolize through urine and prevent kidney damage.
Don’t think that marathon people drink a lot of water just because they are thirsty. In fact, it is also to prevent rhabdomyolysis caused by excessive exercise.
, especially those with abnormal kidney function, should avoid the factors that cause rhabdomyolysis syndrome, otherwise the blow to the kidneys will also be fatal.
also needs to remind everyone that if muscle pain occurs, don’t take painkillers casually. Pain relief tablets are also a blow to the kidney itself. If the cause of muscle pain is rhabdomyolysis, the damage to your kidneys will be added to the fire!
Article source: Zilin's article "Famous doctors in Beijing are in the clinic: cure common diseases, you should do this"
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Zilin
Senior medical media person, medical popularization writer, founder of TopMD platform, producer and host of "Ask for a doctor" and "The Teacher is Coming" columns, and producer of multiple health programs.
also serves as: member of the Oncology Popularization and Control Committee of the Chinese Anti-Cancer Association, member of the Health Management Professional Committee of the Beijing Breast Disease Prevention and Control Society, the first batch of lecturers of the Medical Science Popularization Training Camp Lecturer Group of the Beijing Branch of the Chinese Medical Association, and the first batch of lecturers of the Medical Media Training Camp Lecturer Group of the Peking Union Medical College Medical College.
Experience and Achievements: Original director of Beijing TV health program. In 2017, the publication of "Famous Doctors in Beijing: Treating Common Diseases, You Should Do This" won the Top Ten Online Popularity Award of the China Health Science Popularization Innovation Competition guided by the Publicity Department of the National Health and Family Planning Commission and hosted by the " Health News ". In 2018, the award of the National Top Ten Popular Science Books for the New Era Health Science Popularization Competition awarded by the Ministry of Science and Technology, the China Association for Science and Technology, and the National Health Commission. In 2018, he published "The Start of the Medical Circle" and "The Gastric Cancer You Don't Know", and won the Top Ten Best Medical Science Popularization Books Award in Chinese Medical World in 2018.
is a guest at Beijing Radio Station Traffic Radio and CCTV " Light of Technology ", and was invited to various academic conferences to give lectures on medical popularization writing skills for doctors.
