Rhabdomyolysis: a review, with emphasis on the pediatric population

Abstract

Rhabdomyolysis is a common clinical syndrome and accounts for 7% of all cases of acute kidney injury (AKI) in the USA. It can result from a wide variety of disorders, such as trauma, exercise, medications and infection, but in the pediatric population, infection and inherited disorders are the most common causes of rhabdomyolysis. Approximately half of patients with rhabdomyolysis present with the triad of myalgias, weakness and dark urine. The clinical suspicion, especially in the setting of trauma or drugs, is supported by elevated creatinine kinase levels and confirmed by the measurement of myoglobin levels in serum or urine. Muscle biopsy and genetic testing should be performed if rhabdomyolysis is recurrent or metabolic myopathy is suspected. Early recognition is important to prevent AKI through the use of aggressive hydration. Prevention is important in patients with inherited forms, but novel therapies may be developed with the better understanding of the pathophysiology and genetics of rhabdomyolysis.

Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

“…Statins, fibrates, ciclosporin and antipsychotic medications increase rhabdomyolysis risk. 10 Myoglobin accumulation in renal tubules leads to acute kidney injury. 11 Complications of rhabdomyolysis include acute tubular necrosis, acute renal failure, and shock; however, management depends on its cause but the main goal is to prevent kidney injury.…”

“…The inadequacy of supportive treatment warrants uses of renal replacement therapy and modalities of which include hemodialysis, peritoneal dialysis and continuous hemofiltration. 10 Hyponatremia due to water intoxication and SIADH is reported to cause rhabdomyolysis. 12,13 Many conditions are associated with rhabdomyolysis however it is rarely associated with the Addisonian crisis.…”

McArdle disease: a “pediatric” disorder presenting in an adult with acute kidney injury

“…Drugs and trauma account for up to 80% of cases in the adult population [1,2]. For the small percentage of rhabdomyolysis due to genetic causes, most are diagnosed by adolescence [3]. In this case report, we present an adult patient with rhabdomyolysis secondary to McArdle disease, a genetic and neuromuscular disorder well recognized in the pediatric population.…”

Cardiac arrhythmias and rhabdomyolysis in Bartter–Gitelman patients

“…In addition to its potential to cause cardiac arrhythmias, severe hypokalemia may effect dissolution of the peripheral striated muscle fibers with leakage of the intracellular constituents, a distinctive condition known as rhabdomyolysis [22,23]. The immediate consequences of rhabdomyolysis include hyperkalemia (and hyperphosphatemia) resulting from the release of potassium and phosphorous from damaged muscle, which in turn may cause cardiac arrhythmias, and acute kidney injury.…”

“…The spectrum of severity is broad and varies from an asymptomatic increase in blood creatine kinase level to acute rhabdomyolysis. Hence, we assume (but can not prove) that these factors may enhance the tendency towards rhabdomyolysis in Bartter syndrome [22,23]. Educating Bartter patients, their family members and their family physicians on alcohol abuse and illicit or prescribed drugs that may prolong the QT interval or cause myotoxicity is of tremendous importance.…”