From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis

Abstract

Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath. 'Haff disease', a form of rhabdomyolysis first described in 1920, has fascinated scientists and physicians alike, but the marine toxin causing it remains enigmatic even today. As a specialty, we have also learned a lot about the disease from 20th-century earthquakes, and networks of international help and cooperation have emerged. Finally, rhabdomyolysis has been described as a sequel to torture and similar forms of violence. Clinicians should be aware that rhabdomyolysis and the development of renal medicine are deeply intertwined with human history.

Keywords: AKI; crush injury; history; rhabdomyolysis.

FIGURE 1

Coturnix coturnix (common quail). Image in the public domain via Royal Society of the Protection of Birds at https://www.rspb.org.uk/birds-and-wildlife/wildlife-guides/bird-a-z/quail/ (4 March 2020, date last accessed).

FIGURE 2

Spotted water hemlock (Cicuta maculata), from Clark and Fletcher [37] (image in the public domain).

FIGURE 3

Muscle of patient buried for 6 h and surviving 7 1/2 days showing oedema and necrotic lateral muscles of the leg. From Bywaters [47], with permission.

FIGURE 4

(A) Makeshift dialysis facility in the All Union Surgical Scientific Centre in Yerevan, Soviet Republic of Armenia, 1988. From Tattersall et al. [78] with permission. (B) Improvised dialysis facility using the NxStage device following the Haiti earthquake. With permission from NxStage, Lawrence, MA, USA.

FIGURE 5

A young patient who presented with AKI from rhabdomyolysis following severe traumatic (‘sjambok’) injuries. He recovered fully after receiving dialysis in our ICU. Courtesy of Prof Ikechi Okpechi, Division of Nephrology and Hypertension, University of Cape Town, South Africa.

FIGURE 6

Time line: history and rhabdomyolysis intertwined from 1900 to present day. Bottom half: events relating to armed conflict and violence. Top half: events not associated with human conflict.