Acute Renal Failure Due to Rhabdomyolysis Following a Seizure
A 35-year-old male was referred to our tertiary centre by his primary-care physician with a diagnosis of epidermoid cyst in the anterior interhemispherical area. The patient had history of four to five episodes of generalized tonic clonic for last 10 months. He was evaluated for a generalized tonic clonic seizure episode before referring to our center with magnetic resonance imaging of the brain. There was no history of hypertension, diabetes mellitus, fever, oliguria, muscle weakness, ingestion of toxic substance or illicit drug, or alcohol abuse.\nOn presentation, the patient was conscious, oriented, and afebrile with a pulse rate of 84/min, blood pressure 130/74 mmHg, and respiratory rate 16/min. Fundus examination was normal and there were no signs of meningeal irritation or focal neurological deficit. Examination of abdomen, cardiovascular, and respiratory systems was unremarkable.\nThe initial laboratory tests showed a total leukocyte count of 15,800/mm3, blood urea 54 mg/dl, and serum creatinine 2 mg/dl. Other investigations, including hemoglobin, erythrocyte sedimentation rate, random blood sugar, liver function tests, blood urea nitrogen, electrolytes, urine, arterial blood gas analysis and ultrasound examination of the abdomen, were all within normal limits. HBsAg, HCV, and HIV serology was negative.\nHe was managed with antiepileptic drug and optimal hydration. His urine output decreased, and serum creatinine started to rise and reached a level of 6.23 and 7.79 mg/dl on fourth and sixth day after a seizure episode, respectively. His serum creatine phosphokinase peaked at 9882 U/L. Urine myoglobin estimation could not be done.\nA diagnosis of acute oliguric renal failure due to seizure-induced rhabdomyolysis was made. Renal biopsy performed showed patchy tubular cell necrosis with mild interstitial inflammation. Hemodialysis was started and continued until his urine output became normal in 4 weeks time. On follow up at 8 weeks, he attained normal renal function.