Acute Renal Failure in McArdle’s Disease

R. Marcén, Servicio de Nefrología, Hospital Ramón y Cajal, Carretera de Colmenar, 28034 Madrid (Spain) Dear Sir, In the December issue, Tabata et al. [1] report a new case of acute renal failure in McArdle’s disease which is considered to be the 15th appearing in the literature. We assume they were considering only English publications as non-English journals are scarcely included in the reference lists, perhaps because of little diffusion, lack of knowledge of the language or other difficulties. As a result of these considerations and the rarity of McArdle’s disease we report below the summary of another previously published case [2]. A 24-year-old male patient was admitted to the Hospital because of anuria. Two days before his admission, following exercise, he suddenly lost his strength in the limbs and fell down. Thereafter, discomfort in his back and thighs, nausea, vomiting, emission of dark urine and progressive oliguria developed. He had a history of easy fatigability and exercise intolerance since he was 12 and his father and one brother also complained of similar symptoms. Between the studies performed, the ischemic exercise test was positive, there were no changes in the blood concentration of lactate and the muscular biopsy showed PAS-positive deposits in the muscular sarco-lemma, increased content of muscle glycogen and unde-tectable phorphorilase activity. Thus, a diagnosis of McArdle’s disease was made. The evolution of acute renal failure is shown in fig. 1. Creatine phosphokinase and LDH were 9,000 and 10,000 a CPK, IU/1 x 10 ∆ LDH, IU/1 ¤ SGPT, IU/I 1⁄8A”1⁄81⁄81⁄81⁄8^1⁄8 a Crea†inine, mg/l00 ml ∆ Urea, mg/l00 ml x 10 10 12 14 16 18 20 22 24 30 4 days months Fig. 1. Clinical course of the patient (reproduced with permission of Nefrología, official journal of the Spanish Society of Ne-phrology). CPK = Creatine phosphokinase; PD = peritoneal dialy240 Marcén/Matesanz/Quereda/Orte/Ortüno