Candombe Drumming-Induced AKI

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Hope everybody is having a happy holiday season–even those nephrology fellows (not myself, fortunately) who are required to staff the dialysis unit in lieu of spending time with family and friends.

An unusual cause of acute kidney injury I recently read about was reported in a recent 2008 issue of C-JASN: glomerular hematuria caused by excessive candombe hand drumming.

Candombe hand drumming is a popular form of music in Uruguay. During a carnival-type festival termed “las llamadas”, several individuals will engage in vigorous hand-drumming for several hours. Interestingly, some individuals will report rust-colored urine, and a subset of these individuals will present with a reduced GFR significant enough to require temporary dialysis. Hematuria in affected individuals tended to show dysmorphic red blood cells, suggesting a glomerular source of hematuria. Furthermore, the mechanism suggested by the authors is extravascular hemolysis as a result of repetitive trauma to the hands as a result of drumming–which is suggested by the elevated post-drumming levels of LDH, low levels of haptoglobin, and relatively normal levels of CK & myoglobin to rule out rhabdomyolysis as a significant contributor to renal injury.

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