Rhabdomyolysis: A review

Abstract

Rhabdomyolysis, a syndrome of skeletal muscle breakdown with leakage of muscle contents, is frequently accompanied by myoglobinuria, and if sufficiently severe, acute renal failure with potentially life-threatening metabolic derangements may ensue. A diverse spectrum of inherited and acquired disorders affecting muscle membranes, membrane ion channels, and muscle energy supply causes rhabdomyolysis. Common final pathophysiological mechanisms among these causes of rhabdomyolysis include an uncontrolled rise in free intracellular calcium and activation of calcium-dependent proteases, which lead to destruction of myofibrils and lysosomal digestion of muscle fiber contents. Recent advances in molecular genetics and muscle enzyme histochemistry may enable a specific metabolic diagnosis in many patients with idiopathic recurrent rhabdomyolysis.

Skeletal Muscle Susceptibility to Clofibrate Induction of Lesions in Rats

“…However, they may also cause myopathy and rhabdomyolysis in humans (Lane and Mastaglia, 1978;Hodel, 2002;Warren et al, 2002 ).…”

Serum creatinine and cystatin C provide conflicting evidence of acute kidney injury following acute ingestion of potassium permanganate and oxalic acid

“…Since the levels measured by the two methods are strongly correlated, the early rise of sCr is unlikely to be due to an assay based error (Supplementary Figure 4). Rhabdomyolysis releases cellular contents such as creatine, creatinine and CK [31]. However the early rise of sCr seems unlikely to be due to overt muscle damage as there was minimal rise in CK (Supplementary Figure 5).…”

Statin-Associated Polymyositis Following Omeprazole Treatment

“…Theories suggested are primarily downstream of HMG-CoA reductase inhibition and include instability of skeletal muscle cell membranes by blocking of cholesterol synthesis, 8 decreased synthesis of coenzyme Q10 and mitochondrial dysfunction, 9,10 inhibition of GTP-binding regulatory proteins, and impairment of muscle's ability to appropriately recover from physical exertion. 11,12 While statins can cause myopathy during monotherapy, many cases are associated with drug interactions. Drugs of particular concern include CYP3A4 isoenzyme-dependent drugs such as macrolide antibiotics, azole antifungals, and cyclosporine, [12][13][14] drugs that interact with the glucuronidation pathway such as gemfibrozil, 12 and drugs that interact with the p-glycoprotein efflux system such as proton pump inhibitors (PPIs).…”