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Status Epilepticus Triple Renal Insult — ESENeph MCQ

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ModerateAcute Kidney InjuryStatus Epilepticus Triple Renal InsultESENeph

A 45-year-old man develops AKI after a prolonged seizure lasting 30 minutes (status epilepticus). His CK is 35000 U/L. What additional renal complication beyond myoglobin-induced ATN should be considered?

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Correct answer: A — Seizure-related uric acid release from muscle breakdown can cause acute urate nephropathy – check uric acid level; additionally, metabolic acidosis from lactic acid production during prolonged seizure worsens AKI; combined rhabdomyolysis + urate nephropathy + acidosis creates a triple insult

Prolonged seizures cause massive ATP consumption in muscles, generating lactic acid (metabolic acidosis), releasing myoglobin (rhabdomyolysis), and releasing purines (uric acid from ATP/AMP catabolism). The combination of rhabdomyolysis, hyperuricaemia, and acidosis synergistically injures the kidney: myoglobin and uric acid both precipitate in acidic urine. Management includes aggressive IV fluids (target UO 200-300 mL/hr), urinary alkalinisation if uric acid is very elevated, Rasburicase for severe hyperuricaemia, and seizure control. Checking uric acid alongside CK helps identify the urate component.

Reference: KDIGO 2012 – AKI; Bosch et al 2009 – Rhabdomyolysis