Severe Rhabdomyolysis-Induced AKI Requiring Hemodialysis in an Adolescent with Influenza A

Introduction: Viral infections like Influenza A and Covid -19 related infection can cause rhabdomyolysis and subsequent AKI. Most of these AKI resolve with conservative management. We here in report an adoloscent with Influenza A with severe rhabdomyolysis induced AKI requiring hemodilaysis. Case Description: A 15-year-old male presented with a history of fever, cough, running nose, headache, phonophobia, sore throat, dysphonia, and decreased appetite. He had no known history of liver, kidney, or muscle disorders. He denied any recent history of trauma, immobility (travel, surgery), seizures, new medications, or drug abuse. Physical examination revealed bilateral thigh tenderness and abnormal gait. Laboratory tests were positive for Influenza A, elevated AST/ ALT and elevated BUN/creatinine. Aggressive intravenous fluid resuscitation was initiated. His creatine kinase (CK) levels (>900,000 U/L) started to rise rapidly along with worsening urine output and renal funnction. He developed complete anuria on Day 5 requiring hemodialysis which was done daily initially and then switched to every other day. The patient's urine output and renal function started to improve around Day 8. His CK levels decreased, and urine output returned to normal. Renal function upon discharge showed a creatinine level of 1.6 mg/dL, which further improved to 0.8 mg/dL on subsequent follow up. Discussion: Monitoring musculoskeletal and renal involvement is important when treating patients with severe acute influenza infection.This case highlights the critical nature of rhabdomyolysis induced acute kidney injury post influenza A infection which in some cases may need renal replacement therapy like hemodialysis. lab results - Day of hospitalization Serum creatinine Blood urea nitrogen creatine phosphokinase Aspartate aminotransferase/Alanine transaminase 2 4.8 42 941531 3693/891 6 5.5 38 118380 2003/460 15 8.1 89 6636 147/141 21 4.5 69 1397 66/114