Non-Traumatic Rhabdomyolysis With Acute Renal Failure

Abstract

A clinical pro®le of non-traumatic rhabdomyolysis with acute renal failure is presented. Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed.

Toxicant-Induced Rhabdomyolysis

“…Contributing factors seem to be concentrated urine with low urine flow and urine pH less than 5.6. Published clinical reviews conclude that patients with hyperkalemia, hyperphosphatemia, high serum myoglobin concentrations, and low myoglobin clearance seem to be at risk for development of acute kidney injury [9,18,[63][64][65][66].…”

“…There is complete agreement that early and aggressive volume resuscitation, sufficient to restore adequate renal perfusion and increase urine flow, is the standard of care in preventing acute kidney injury in patients with rhabdomyolysis (Level II-2 recommendation) [2,[68][69][70][71][72][73]. In animals with rhabdomyolysis that had a low urinary pH, dehydration predisposed to renal injury, which was prevented with urinary dilution [55,66,74]. In addition, hypovolemia may occur as a result of movement of fluid into the traumatized muscle and/or to hyperthermia.…”

“…Hyperphosphatemia may require administration of phosphate binders and treatment is dictated by the degree of phosphate elevation. In addition, hypocalcemia may occur early in the clinical course of rhabdomyolysis [66]. However, calcium should not be administered unless hyperkalemia or ventricular dysfunction occurs since calcium infusion may increase deposition of calcium in injured muscle.…”