Kidney damage due to excess of myoglobin released from skeletal muscle breakdown is rhabdomyolosis. In this article, we unfolded the causes, symptoms, investigations, treatment, prognosis and complications of rhabdomyolysis.
Rhabdomyolysis is a condition that results in the rapid breakdown of skeletal muscle, which results in the leakage of a muscle protein (myoglobin) into the blood and urine. The skeletal muscle helps in the movement of joints. Myoglobin stores oxygen in the muscles. Too much myoglobin in the blood causes kidney damage. Various causes can result in this condition. Rhabdomyolysis results in muscle pain and weakness.
In the US, around 26,000 cases are reported every year. The treatment includes IV fluids and dialysis or hemofiltration if kidney functioning has been affected. Some medications can also result in rhabdomyolysis due to muscle. The levels of muscle enzymes, CPK (creatinine phosphokinase), SGOT (serum glutamic oxaloacetic transaminase), SGPT (serum glutamic pyruvic transaminase), and LDH (lactate dehydrogenase) are elevated in these patients. Severe cases might need hospitalization.
This condition is triggered by an injury, which can be physical, genetic, or chemical, to the muscles. Any condition or medication that damages the muscles can result in rhabdomyolysis. The following are some of the possible causes:
Injury and Exertion -
Crush injury (something heavy falls on a person).
Severe burn injury.
Blood vessel blockage.
Getting struck by lightning.
An injury that cuts of blood supply to a part of the body (ischemic limb injury).
Running a marathon or intense exercise.
Metabolic Conditions -
Problems with the metabolism of lipids, fats, carbohydrates, or purines (present in liver, asparagus, fatty fishes).
Diabetic ketoacidosis (buildup of ketones).
Hypothyroidism (low levels of thyroid hormones).
Genetic Conditions -
Duchenne muscular dystrophy.
Lactate dehydrogenase deficiency.
Statins (Atorvastatin, Rosuvastatin, Pravastatin).
LSD (Lysergic acid diethylamide).
The early symptoms are not specific and often mimic other conditions. Some of the common symptoms include:
Decreased urine output.
Dark-colored urine (tea-colored).
Rhabdomyolysis is diagnosed by correlating the history of recent and past events, physical examinations, blood, and urine testing. Your doctor might ask you about any medication use, drug or alcohol abuse, preexisting medical conditions, any recent injury or accident, etc. If your symptoms and history point towards this, then the following tests might be done.
Blood tests, which include complete blood count (CBC), a metabolic panel, muscle enzymes, and urinalysis. The following factors are used to diagnose rhabdomyolysis:
Elevated levels of myoglobin in blood and urine.
Elevated muscle enzymes, such as creatine phosphokinase (CPK), SGOT, SGPT, and LDH, in the blood. These enzymes are the byproducts of muscle destruction. Elevated SGOT and SGPT, without elevated CPK, indicates liver damage.
Potassium will be elevated, as it leaks from injured muscles.
Creatinine might be elevated in the blood and urine.
If detected early, this condition can be successfully treated without any permanent damage to the liver and kidneys. The treatment options include:
Fluid Replacement - It is crucial for the body to get enough fluids. For this, IV fluids should be started immediately. The bicarbonate in the fluid helps flush the protein myoglobin from the kidneys.
Bicarbonate and some diuretics are prescribed to help the proper functioning of the kidneys.
IV fluids - To treat high levels of potassium (hyperkalemia) and low levels of calcium (hypocalcemia), appropriate IV fluids are administered.
Dialysis - In severe cases, where the kidney and liver damage have already begun, then dialysis is done. Here, the patient’s blood is taken out of the body, so that it can be cleaned in a dialysis unit, which helps remove waste products. Then purified blood is transferred back to the body.
If the patient is not exhibiting severe symptoms, home remedies can help with recovery. The goal is to rest the body so that the muscles rehydrate and recover, which will prevent further organ damage. Some home remedies include:
Identifying the cause, for example medicines, and discontinue them after talking to your doctor.
Relax and sit in a comfortable position when you feel fatigued.
Keep drinking water and other fluids to flush out myoglobin from the body.
Sip on herbal teas or clear soups.
The following are the possible complications of rhabdomyolysis:
Kidney failure - It is one of the most dreaded complications. The causes include direct kidney injury or clogging of the kidney’s filtering tubes by the muscle proteins (myoglobin). This impairs kidney function and can also result in kidney failure.
Compartment syndrome - It is another serious complication, where a confined space becomes swollen, which increases the pressure in that space. This results in reduced blood flow, which can result in tissue necrosis. This complication is commonly seen after an injury to the body’s extremities.
Electrolyte imbalance - Muscle injury results in the breakdown of muscles, which causes the levels of potassium and phosphorus in the blood to rise. Hyperkalemia and hyperphosphatemia can lead to electrolyte imbalance in the body.
As long as this condition is detected and treated early, the prognosis or treatment outcome is good. Most cases of rhabdomyolysis are reversible. But in severe cases, kidney damage and electrolyte imbalance will need hospitalization and regular dialysis.
To prevent rhabdomyolysis, make sure you drink enough water before and after running a marathon or strenuous exercise. If you have been diagnosed with this condition, take rest and keep yourself hydrated. Always drink water as soon as you feel a little thirsty, and avoid waiting till your mouth and throat are completely dry. If you are suffering from an infection, then make sure you consult a doctor and take antibiotics, as infections can also cause rhabdomyolysis. In case you have a degenerative muscle condition, go for regular checkups.
For more information on rhabdomyolysis, consult a doctor online now!
Rhabdomyolysis is a severe life-threatening syndrome. This condition usually occurs due to a breakdown of skeletal muscle fibers in the body, leading to the leakage of muscle contents into the blood circulation. The most common causes of rhabdomyolysis are crush injury from a road traffic accident, excessive physical activities more than the skeletal muscles’ capability, alcohol abuse, and certain other medicines and toxic substances.
Yes, rhabdomyolysis can be treated. Most of the affected people with rhabdomyolysis are being treated with the help of fluids given through their veins as an intravenous (IV) drip. Some patients with severe rhabdomyolysis might even require dialysis or hemofiltration to address kidney damage in people.
The primary factor that decides the time period of rhabdomyolysis is the degree of kidney damage. If people in whom rhabdomyolysis has been diagnosed early, he or she may be able to avoid several major complications and return to their normal routine activities in a very few weeks. However, once a person is affected by rhabdomyolysis, they might still have certain lingering weakness and pain in their muscles even after getting cured.
The primary goal of treatment is to address the ongoing kidney damage caused due to rhabdomyolysis and avoid the incidence of unnecessary life-threatening complications. The following is the list of medicines and their brand names which are noted to provide the best cure for rhabdomyolysis:
- Atorvastatin (Lipitor).
- Rosuvastatin (Crestor).
- Pravastatin (Pravachol).
Unlike other conditions that affect the skeletal muscle, rhabdomyolysis causes extreme pain where the skeletal muscles become very stiff and rigid. The muscles become so rigid that it could be so hard for the affected individual even to move. At the hospital, the affected patients with rhabdomyolysis describe the pain as an excruciating one. The pain is not similar to the pain that is caused by normal workouts.
The “classic triad” of rhabdomyolysis symptoms are as follows:
- Muscle pain in the shoulders, thighs, or lower back.
- Muscle weakness with associated trouble in moving arms and legs.
- Passage of dark red or brown urine or decreased urination.
Yes, dehydration and severe overheating are one of the chief causes of rhabdomyolysis. The reason behind this is that heat can cause a faster breakdown of muscles when compared to normal. The other causes of rhabdomyolysis are as following:
- High-intensity physical exercises.
- Starting a difficult exercise program too fast can lead to the development of rhabdomyolysis. This is because, in this situation, the skeletal muscles will not have adequate time to heal after an intense workout.
Rhabdomyolysis symptoms in an affected individual can usually develop in a period of one to three days after the muscle injury has happened. However, some affected people may not even experience muscle soreness. The initial and persisting sign of rhabdomyolysis is noted to be muscle swelling.
All types of healthy fluids, such as fruit juices, can be drunk for rhabdomyolysis. The affected individuals are usually advised to drink an increased quantity of liquids if they are doing strenuous work, exercise, and if the environment is warm outside. The reason behind this is that liquids can help in flushing out substances from the body. It is also important to note that certain beverages such as alcohol and caffeine should be avoided because they can increase the risk of rhabdomyolysis.
Rhabdomyolysis is a very important medical emergency that requires immediate medical attention. If you have any of the following symptoms, you are advised to immediately rush to the emergency room.
- Passage of dark, brownish, or pinkish-red urine.
- Unusually stiff, painful, or tender muscles.
- The sudden and steady development of muscle swelling.
The most common and serious complication of rhabdomyolysis is noted to be an acute renal failure. This complication is noted to occur in approximately 15 percent of patients with this condition. Early diagnosis of the condition and prompt medical management of complications is very crucial to bring out a successful outcome.
The following is a list of certain tips and precautions to prevent and stop rhabdomyolysis.
- You can prevent the occurrence of rhabdomyolysis by drinking plenty of fluids before and after a strenuous workout session. This will help dilute your urine and help your kidneys eliminate any myoglobin that your muscles might have released during exercise.
- Always do a difficult category of workouts with proper expert guidance.
- Do not do a difficult workout as a beginner. Do it step by step from the easiest ones to the difficult ones.
Yes, some people might have mild rhabdomyolysis. Some symptoms of rhabdomyolysis are muscle swelling, weakness, and tenderness of the affected muscles. However, mild cases may not experience any symptoms.
Yes, for people affected only with a mild type of rhabdomyolysis, home treatment can help very well and aid in the recovery process. The aim of at-home treatment of rhabdomyolysis includes:
- The affected person should rest so that muscles can recover.
- Rehydration to help prevent further kidney damage.
- Pain medications as per doctor's advice.
The following are the signs that can make the doctor highly suspective of rhabdomyolysis.
- Muscle pains.
- Tea-colored urine.
- Irregular heartbeat.
If the condition is diagnosed and treated early, you can avoid many significant complications and expect a complete recovery in a few weeks. Recovery from rhabdomyolysis due to exercise, with no major complications, can take a period of about several weeks to months for the patient to return to their routine without recurrence of symptoms.
Last reviewed at:
21 Feb 2020 - 5 min read
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