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Definition Return to top
Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle fiber contents into the circulation. Some of these are toxic to the kidney and frequenty result in kidney damage.Causes, incidence, and risk factors Return to top
Myoglobin is an oxygen-binding protein pigment found in the skeletal muscle. When the skeletal muscle is damaged, the myoglobin is released into the bloodstream. It is filtered out of the bloodstream by the kidneys. Myoglobin may occlude the structures of the kidney, causing damage such as acute tubular necrosis or kidney failure.
Myoglobin breaks down into potentially toxic compounds, which will also cause kidney failure. Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the relative fluid volume of the body and leading to shock and reduced blood flow to the kidneys.
The disorder may be caused by any condition that results in damage to skeletal muscle, especially trauma.
Risk factors include the following:
Symptoms Return to top
Signs and tests Return to top
An examination reveals tender or damaged skeletal muscles.Treatment Return to top
Early and aggressive hydration may prevent complications by rapidly eliminating the myoglobin out of the kidneys. The hydration needs with muscle necrosis may approximate the massive fluid volume needs of a severely burned patient. This may involve intravenous administration of several liters of fluid until the condition stabilizes.
Diuretic medications such as mannitol or furosemide may aid in flushing the pigment out of the kidneys. If the urine output is sufficient, bicarbonate may be given to maintain an alkaline urine state. This helps to prevent the dissociation of myoglobin into toxic compounds.
Hyperkalemia should be treated if present. Kidney failure should be treated as appropriate.
Expectations (prognosis) Return to top
The outcome varies depending on the extent of kidney damage incurred.Complications Return to top
Calling your health care provider Return to top
Call your health care provider if symptoms indicate rhabdomyolysis may be present.Prevention Return to top
After any condition that may involve damage to skeletal muscle, hydration should be adequate to dilute the urine and flush the myoglobin out of the kidney. Update Date: 10/17/2003 Updated by: Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |