증례 : 고삼투압성 비케톤성 당뇨병 혼수 환자에서 횡문근 융해증에 의한 급성신부전을 보인 1 예

Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma and may lead to acute renal failure secondary to myoglobinuria. The most sensitive marker of muscle cell damage is serum creatine kinase concentration. It was first described by Bywaters and Beall in association with crush injuries during the second world war, and since then it has been recognized as the cause of about 5 % of all cases of acute renal failure. But acute renal failure is extremely rare in diabetic patient with hyperosmolarity irrespective of the frequency of rhabdomyolysis. Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic hyperosmolar state with acute renal failure, secondary to rhabdomyolysis. We reported a case with diabetic hyperosmolar nonketotic coma who developed acute renal failure secondary to rhabdomyolysis and myoglobinuria in a 60 year old patient with review of the literatures.