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Rhabdomyolysis

 

Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.

Causes

When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can damage kidney cells.

Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle.

Problems that may lead to this disease include:

  • Trauma or crush injuries
  • Use of drugs such as cocaine , amphetamines, statins, heroin , or PCP
  • Genetic muscle diseases
  • Extremes of body temperature
  • Ischemia or death of muscle tissue
  • Low phosphate levels
  • Seizures or muscle tremors
  • Severe exertion, such as marathon running or calisthenics
  • Lengthy surgical procedures
  • Severe dehydration

Symptoms

 

Symptoms may include:

  • Dark, red, or cola-colored urine
  • Decreased urine output
  • General weakness
  • Muscle stiffness or aching ( myalgia )
  • Muscle tenderness
  • Weakness of the affected muscles

Other symptoms that may occur with this disease:

  • Fatigue
  • Joint pain
  • Seizures
  • Weight gain (unintentional)

 

Exams and Tests

 

A physical exam will show tender or damaged skeletal muscles.

The following tests may be done:

  • Creatine kinase (CK) level
  • Serum calcium
  • Serum myoglobin
  • Serum potassium
  • Urinalysis
  • Urine myoglobin test

This disease may also affect the results of the following tests:

  • CK isoenzymes
  • Serum creatinine
  • Urine creatinine

 

Treatment

 

You will need to get fluids containing bicarbonate to help prevent kidney damage. You may need to get fluids through a vein (IV). Some people may need kidney dialysis.

Your health care provider may prescribe medicines including diuretics and bicarbonate (if there is enough urine output).

Hyperkalemia and low blood calcium levels (hypocalcemia) should be treated right away. Kidney failure should also be treated.

 

Outlook (Prognosis)

 

The outcome depends on the amount of kidney damage . Acute kidney failure occurs in many people. Getting treated soon after rhabdomyolysis begins will reduce the risk of permanent kidney damage.

People with milder cases may return to their normal activities within a few weeks to a month. However, some people continue to have problems with fatigue and muscle pain.

 

Possible Complications

 

Complications may include:

  • Acute tubular necrosis
  • Acute renal failure
  • Harmful chemical imbalances in the blood
  • Shock (low blood pressure)

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of rhabdomyolysis.

 

Prevention

 

Drink plenty of fluids after strenuous exercise. This will help to dilute your urine and flush any myoglobin that is released from your muscles out of your kidneys. Also drink a lot of fluids after any condition that may have damaged skeletal muscle.

 

 

Open References

References

O'Connor FG, Deuster PA. Rhabdomyolysis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 115.

Shafuddin AA, Weisbord SD, Palevsky PM, et al. Acute kidney injury. In: Taal MW, Chertow GM, Marsden PA, et al, eds. Brenner and Rector's The Kidney . 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 30.

 
  • Male urinary system

    Male urinary system - illustration

    The urinary system is made up of the kidneys, ureters, urethra and bladder.

    Male urinary system

    illustration

    • Male urinary system

      Male urinary system - illustration

      The urinary system is made up of the kidneys, ureters, urethra and bladder.

      Male urinary system

      illustration

    Tests for Rhabdomyolysis

     
       

      Review Date: 9/22/2015

      Reviewed By: Charles Silberberg, DO, private practice specializing in nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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