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Rhabdomyolysis: Causes, Symptoms & Treatment

Rhabdomyolysis is a serious condition in which muscle tissue breaks down, releasing harmful substances into the bloodstream that can lead to acute kidney failure.

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Things worth knowing about "Rhabdomyolysis"

Rhabdomyolysis is a serious condition in which muscle tissue breaks down, releasing harmful substances into the bloodstream that can lead to acute kidney failure.

What is Rhabdomyolysis?

Rhabdomyolysis is a potentially life-threatening condition in which skeletal muscle cells break down and release their contents into the bloodstream. The protein myoglobin is particularly dangerous, as high concentrations can damage the kidneys and lead to acute kidney failure. The term comes from Greek: "rhabdo" refers to the rod-like shape of muscle fibers, "myo" means muscle, and "lysis" means breakdown or dissolution.

Causes

Rhabdomyolysis can be triggered by a wide range of factors. A distinction is made between traumatic and non-traumatic causes:

Traumatic Causes

Severe physical injuries (e.g., crush syndrome from accidents)
Prolonged immobilization (e.g., after loss of consciousness)
Electrical injuries or burns

Non-Traumatic Causes

Excessive physical exertion (e.g., extreme exercise or overtraining)
Medications, especially statins (cholesterol-lowering drugs) and certain antibiotics
Drug or alcohol abuse
Infections (e.g., influenza, COVID-19)
Metabolic disorders (e.g., hypokalemia, hyponatremia)
Genetic muscle diseases
Hyperthermia (heatstroke) or hypothermia

Symptoms

Symptoms of rhabdomyolysis can vary and are not always clear-cut. Common signs include:

Muscle pain, weakness, or stiffness
Dark, brown, or tea-colored urine (myoglobinuria) – an important warning sign
Swollen or tender muscles
General weakness and fatigue
Decreased urine output or complete absence of urine (anuria)
Nausea, vomiting, confusion (in severe cases)

Note: In mild cases, symptoms can be minimal or absent, making laboratory tests essential for diagnosis.

Diagnosis

Diagnosis is primarily based on blood and urine tests:

Creatine kinase (CK): A significantly elevated CK level in the blood is the most important marker. In rhabdomyolysis, values are often more than 5 times above the normal range.
Urinary myoglobin: Detection of myoglobin in the urine confirms muscle fiber breakdown.
Kidney function tests: Creatinine and urea are measured to assess renal function.
Electrolytes: Potassium, calcium, and phosphate levels can be significantly altered due to cell breakdown.
ECG: To monitor for cardiac arrhythmias, especially in cases of hyperkalemia.

Treatment

Treatment depends on the severity of the condition and the extent of kidney involvement:

General Measures

Aggressive fluid resuscitation (intravenous saline infusion) is the cornerstone of therapy. It promotes the excretion of myoglobin through the kidneys.
Elimination of the triggering cause (e.g., discontinuation of the causative medication)
Close monitoring of kidney function and electrolytes

In Severe Cases

Dialysis: If the kidneys fail and adequate urine output can no longer be maintained, temporary dialysis may be required.
Intensive care management in cases of multi-organ failure

Complications

If left untreated, rhabdomyolysis can lead to serious complications:

Acute kidney failure (the most common and most dangerous complication)
Hyperkalemia (excess potassium in the blood) with cardiac arrhythmias
Disseminated intravascular coagulation (DIC) – a clotting disorder
Compartment syndrome (increased pressure within muscle tissue)
Multi-organ failure in severe cases

Prognosis

With early diagnosis and prompt treatment, the prognosis for rhabdomyolysis is generally good. Most patients recover fully when the underlying cause is addressed and kidney function is protected in time. However, severe cases involving multi-organ failure carry a more serious prognosis.

References

Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. New England Journal of Medicine. 2009;361(1):62-72.
Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065.
World Health Organization (WHO). Management of renal failure in resource-limited settings. Geneva: WHO Press, 2016.

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