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Wave of renal impairment
  1. Helena Pinto1,
  2. Ana Catarina Teixeira1,
  3. Nuno Oliveira1,
  4. Rui Alves1,2
  1. 1Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  2. 2Clínica Universitária de Nefrologia, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
  1. Correspondence to Dr Helena Pinto, helenasofiapinto{at}


We present a case of a 51-year-old man who went to the emergency department after an almost-drowning episode, presenting with muscular weakness, myalgia and dark urine. Laboratory data showed a severe rhabdomyolysis (creatine kinase 497 510 U/L). Despite aggressive fluid therapy, an oliguric acute kidney injury was established with temporary need of haemodialysis. The patient had a longtime history of exercise intolerance and family history of a metabolic myopathy, namely a sister with McArdle’s disease. The genetic test was positive. McArdle’s disease is an autosomal recessive disorder caused by mutations in the muscle glycogen phosphorylase gene that encodes the myophosphorylase. The main symptom consists in exercise intolerance and the most severe complication is rhabdomyolysis with acute renal failure. Metabolic myopathies, such as McArdle’s disease, should be considered in patients with acute renal failure due to unexplained severe rhabdomyolysis, especially if there are chronic complaints of exercise intolerance and positive family history.

  • metabolic disorders
  • acute renal failure
  • fluid electrolyte and acid-base disturbances
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  • Contributors HP contributed to the article with the conception of the manuscript, acquisition, analysis and interpretation of data and drafting the work. ACT contributed to the article with the conception of the manuscript and to the acquisition, analysis and interpretation of data. NO contributed to the article with the conception of the manuscript, with bibliographic research and revising it critically for important intellectual content. RA contributed to the article revising it critically for important intellectual content and to approval of the final version of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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