Exercise-Induced Rhabdomyolysis: A Case Report and Literature Review

Abstract

A 19-year-old man presented to the ED with bilateral leg pain and dark discoloration of the urine after he started an intense aerobic exercise. Blood workup showed significantly elevated creatine kinase (CK), acute kidney injury (AKI), and disseminated intravascular coagulation (DIC). The patient had a double-incision, bilateral fasciotomy with debridement to relieve the bilateral, lower-limb, compartment syndrome following admission. Also, his kidney function deteriorated, requiring several sessions of hemodialysis. His hospital stay was complicated by multidrug-resistant (MDR) Acinetobacter baumannii bacteremia. After three weeks of hospital admission, the patient was discharged home with a follow-up outpatient physiotherapy for bilateral foot drop, which showed a remarkable recovery eventually. This case highlights the potentially life-threatening risks associated with unaccustomed physical exercise and emphasizing the essential preventive measures to reduce the risk of developing exercise-induced rhabdomyolysis. We present the pathophysiology of exercise-induced rhabdomyolysis, clinical presentation, diagnosis, treatment, and prognosis.

Exercise-Induced Rhabdomyolysis Causing Acute Kidney Injury: A Potential Threat to Gym Lovers

“…The exercise-induced rhabdomyolysis is a sub-division of exertion-induced rhabdomyolysis, saying that exercise-induced occurs in those who have a high risk of developing factors that include exercise done by an untrained person, certain types of exercise (eccentric) muscle lengthening, and downhill exercises, or exercise done for prolong time beyond personal capacity [3][4][5][6]. Along with it, predisposing factors can contribute to developing it, which include dehydration, humid and hot temperatures [7][8], certain genetic mutations [9], and alcohol and heroin use [10,11].…”

“…The exact mechanism of exercise inducing rhabdomyolysis has been postulated with a decrease or depletion of adenosine triphosphate (ATP) during heavy exercises for a prolonged time. Low levels of ATP lead to shutting down calcium channels and leading to increased levels of intracellular calcium, which activates protease and phospholipase A2, which break down the intracellular structures leading to cell death [3,4]. The incidence of acute renal failure in patients with exercise-induced rhabdomyolysis is around 10-30% [3][4]13].…”

“…Low levels of ATP lead to shutting down calcium channels and leading to increased levels of intracellular calcium, which activates protease and phospholipase A2, which break down the intracellular structures leading to cell death [3,4]. The incidence of acute renal failure in patients with exercise-induced rhabdomyolysis is around 10-30% [3][4]13]. The primary cause is the release of muscle's intracellular contents, mostly myoglobin, which is freely filtrated through the glomerular basement membrane and accumulated into tubules, leading to acute kidney injury.…”

“…The term rhabdomyolysis is defined as the breakdown of striated muscles resulting from direct or indirect trauma to the muscle, which potentially releases its intracellular contents (myoglobin, creatine kinase {CK}, aldolase, and lactate dehydrogenase) in blood circulation resulting in devastating complications to body organs like an acute renal failure and disseminated intravascular coagulation (DIC) [1]. The exercise-induced rhabdomyolysis is caused after having heavy exercise, a sudden onset start of exercise, or exercise done for a prolonged time [1][2][3]. It is potentially seen and growing in large numbers in younger adults as influenced by social media platforms to have six packs abs as a body complexion [2,4].…”

Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

“…RM is a syndrome characterized by rapid breakdown and leakage of skeletal muscle cell contents [19], such as myoglobin, CK, and other cytokines. During the past several decades, there have been multiple and diverse causes of RM, which include trauma, toxins, infections, drugs, and strenuous exercise [20][21][22][23][24][25][26]. The major cause of RM in our study was determined to be infections (36.2%), including Staphylococcus aureus, Streptococcus pneumoniae, and klebsiella pneumoniae.. All 86 cases presented with certain classical symptoms, such as muscle weakness, myalgia, or dark -colored urine, along with signi cantly higher CK levels, and without red blood cells in the urine sediment.…”