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Muscle Destruction and Kidney Failure

more about Muscle Destruction and Kidney Failure

Rhabdomyolysis, Myoglobinuria

  • In this condition, the destruction of muscle cells releases myoglobin and Potassium into the blood stream, causing damage to the kidneys and possible renal (kidney) failure.

  • May have no symptoms
  • Muscle pain and tenderness
  • Muscle swelling, Bruising
  • Weakness
  • Urine may be Coca-Cola colored (due to myoglobin)
  • There may be joint pain

  • Trauma to the skeletal muscles, such as falls, auto accidents, and burns; seizures; prolonged bed rest; physical assault; head injury; prolonged bed rest; body building; and military exercise training
  • Infections -- virus (Measles, Herpes, HIV, varicella, etc.), bacteria, parasites
  • Disorders and diseases:
    1. Genetic or inherited diseases in which the gene for making a particular enzyme or chemical may be missing or abnormal (i.e., central core disease or acetyl-CoA dehdrogenase deficiencies, Sjogren's Syndrome, cytochrome b deficiency, glycogen storage diseases like McArdle's)
    2. Diabetes ketoacidosis
    3. Myopathies (muscle disorders) -- Polymyositis or dermatomyoitis
  • Electrolyte imbalances:
    1. Hypokalemia, Hypophosphatemia
    2. Hyperthermia or heat injury (stroke)
  • Toxins or drugs (often by causing other conditions, i.e., seizures, Coma, Neuroleptic malignant syndrome, Potassium excretion, Renal tubules damage or direct muscle damage):
    1. Barbiturates.
    2. Amphetamine.
    3. Ethanol (Alcohol).
    4. Ecstasy.
    5. LSD.
    6. Cocaine.
    7. Heroin.
    8. Snake venom -- Cobra, Viper, rattlesnake
    9. Insect venom -- Wasps, African bee, brown recluse spider
    10. Carbon monoxide
    11. Metaldehyde
    12. Theophyline
    13. Haloperidol
    14. Rohypnol
    15. Lithium
    16. Salycilates
    17. Thiazide diuretics
    18. Toluene
    19. Amphotericin
    20. Clofibrate and other lipid-lowering drugs
    21. Thyroid hormone
    22. Many others

  • History of symptoms, injury, illnesses, family history, surgeries, habits, medications, drugs, travels, occupation
  • Medical exam may reveal tender muscles.
  • Tests:

    1. Low urine amount or volume due to kidney or renal injury from Rhabdomyolysis
    2. Urine color is red or Coca-cola colored.
    3. Urine dip stick test may show presence of myoglobin pigment from the damaged muscle fibers, hemoglobin from damaged red blood cells, red blood cells, and clusters of pigment (casts).
    4. Blood tests will show elevation of muscle enzymes (normal muscle chemicals that are released after muscle damage) such as Creatinine kinase, aldolase, and lactic dehydrogenase; worsening renal functions (elevated BUN and Creatinine); increased Potassium, Phosphorus, Uric acid levels.
    5. Blood levels of Calcium are low (hypocalcemia) in the first stages of Rhabdomyolysis and during resultant kidney damage (acute tubular necrosis), but increase during recovery period.
    6. Electrocardiogram -- measures electrical activities of the heart -- is done, since increased Potassium levels (hyperkalemia) may cause dangerous heart rhythm irregularities.

  • Nursing home patients
  • Alcoholics
  • Post-surgery
  • Drug abuse
  • Any age -- seen in infants with genetic abnormalities
  • Males > females
  • See causes

  • Inpatient treatment in the hospital is necessary.
  • Aim is to prevent renal or kidney failure.
  • Intravenous or IV (in to the veins) fluids help flush and clear the kidneys of damaging muscle pigments and chemicals.
  • Mannitol and Lasix are diuretics that by increasing urination help to further flush the kidneys.  They are given IV.
  • Decreasing the urine's acidity with Sodium Bicarbonate may also aid in flushing the kidneys.
  • Treatment of hyperkalemia (using Insulin, glucose, Kayexalate) and Hypocalcemia (Vitamin D and Calcium gluconate) is necessary.
  • In some cases of kidney failure, kidney dialysis must be done using a machine that filters and clears the blood of body toxins until the kidneys recover and can perform their normal function of removing bodily waste and toxins.

  • Call 911.

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