Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians

Abstract

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

Figure 1

Overview of the pathophysiology of rhabdomyolysis. CK, creatine kinase.

Figure 2

Mechanisms of heme-induced renal failure.

Figure 3

Pigmented casts. Analysis of urinary sediment (×400) pigmented casts, leukocyturia, and hematuria without dysmorphic red cells. (a) Pigmented casts, leukocyturia, hematuria with dysmorphic cells; (b) with antibody against human myoglobin.