Objectives: To analyze patients with rhabdomyolysis, assessing clinical presentation and prevalence of acute renal failure.
Material and methods: We performed a retrospective study of patients younger than 16 years of age with creatine-phospokinase (CPK) levels greater than 1,000 IU/L who were attended at our tertiary pediatric hospital during a 2.5 year period. Neonatal patients and those with elevation of myocardial specific form of CPK were excluded. Acute renal failure was assessed according to RIFLE criteria adapted to pediatric patients. Clinical and laboratory data were collected.
Results: A total of 55 patients were included (median age 8 years). The median initial CPK level was 1,826 IU/L (range: 1,213-4,414). The most common etiologies were viral myositis, muscle surgery and seizures. Acute renal failure that was unrelated to the cause of rhabdomyolysis occurred in 15.9% and was related to higher levels of CPK. None of them required renal replacement therapy.
Conclusion: Acute renal failure in children is usually mild and it is more likely to happen in children with higher levels of CPK.

Among the pathologies related to heat, called heat stroke both classic heat stroke and exertional heat stroke, is the most serious, represented a threat to the patient's life. This entity is defined as an elevation in core body temperature over 40 °C and central nervous system dysfunction (confusion, ataxia, seizures or coma). Complications could be severe, including acute renal failure, liver failure, rhabdomyolysis, cardiovascular collapse, electrolyte disturbances, thrombocytopenia, disseminated intravascular coagulation and multiorgan failure. Heat stroke happens when heat loss mechanisms are overwhelmed and an imbalance between production and heat loss occurs. There are also intrinsic factors (age, sex, chronic illness, drugs, volumen depletion, obesity...) and extrinsic (temperature and humidity, physical effort...) that may contribute to the development of heat stroke. The treatment is based on immediate cooling, support of organ-system function and prevention of systemic complications. Prognosis depends on severity of insult to the central nervous system and the intensity and duration of hyperthermia. Heat stroke is a preventable illness, and thorough knowledge of the disorder can help to reduce mortality and morbidity.
We report a 13-year-old boy who is being treated with topiramate and methylphenidate and he suffer a heat stroke while he is doing physical effort in a hot environment and we describe the symptoms that make up this entity.