Urological Health Chronic Kidney Disease Overview of Rhabdomyolysis Breakdown of your muscles could hurt your kidneys as well By Veeraish Chauhan, MD Updated on July 17, 2022 Medically reviewed by Jamin Brahmbhatt, MD Fact checked by Heather Mercer Print Rhabdomyolysis, sometimes called "rhabdo" in clinical parlance, implies "breakdown of muscles". It is a clinical syndrome where muscles begin to breakdown and lead to alterations in the level of fluid and electrolytes in the body, thus leading to harmful consequences. Rhabdomyolysis. David Sacks / Getty Images Causes of Rhabdomyolysis Multiple factors have been associated with rhabdomyolysis. Here are a few examples: Medications; eg. statins and fibrates (drugs used to lower cholesterol), colchicine (a gout medication), psychotropics, antibiotics, steroids, etc. Excessive strenuous exercise which leads to a phenomenon called exercise-induced rhabdomyolysis or exertional rhabdomyolysis High temperatures causing heat stroke are a predisposing factor. Illicit drugs like cocaine and amphetamines, and alcohol Symptoms of Rhabdomyolysis Typically, the affected patient will report extreme muscle pain, muscle stiffness, swelling, weakness, and sometimes "dark/cola-colored urine". Dehydration is common, and the patient could have changes in mental status and low blood pressure leading to light-headedness, dizziness, decreased urine output, etc. Fever can be present as well. How Rhabdomyolysis Affects the Kidney Rhabdomyolysis impacts kidney function in multiple ways. The breakdown of muscles leads to the movement of body fluid out of the blood vessels into the injured muscle, essentially creating and worsening a state of dehydration. This by itself is sometimes enough to cause a severe decline in kidney function, often called acute kidney injury. Electrolyte levels can also change in the blood and can be manifested by: Increased phosphorus levelsDecreased calcium levelsIncreased potassium levelsIncreased uric acid levels Another way by which rhabdomyolysis hurts the kidney is a phenomenon called myoglobinuria. Myoglobin is a protein found in the muscles. When muscles break down, this myoglobin is released into the blood from where it makes its way to the kidney. The kidneys are not good at excreting myoglobin and this protein besides being toxic to the kidneys' cells, will often clog up the kidneys' "drainage system" called the tubules. This could lead to kidney failure. In worst case situations, rhabdomyolysis-induced kidney failure because of myoglobinuria can lead to irreversible kidney failure requiring long-term dialysis. Rhabdomyolysis Diagnosis The diagnosis of rhabdomyolysis depends on the clinical presentation which includes the symptoms and the signs of presentation like muscle aches. Some more specific symptoms would include cola-colored urine. Lab tests are done to support the diagnosis and will often show a significantly elevated level of a chemical in the blood called creatinine phosphokinase (CPK). Kidney failure may be apparent on the blood test as well, with elevated creatinine levels. A urine test might show the presence of myoglobin, the abnormal protein released into the urine from muscle breakdown. Rhabdomyolysis Treatment Besides treating the primary cause that led to it, the crux of treatment of rhabdomyolysis is correcting the abnormal electrolyte levels and aggressive hydration of the affected patient with intravenous fluids. There has been some debate about what kind of intravenous fluid is best for a patient in this situation. For many years, alkalinizing the urine with sodium bicarbonate and mannitol has been the standard of care. However, its superiority over other intravenous fluids like normal saline has never been emphatically proven. The treating doctor will trend your kidney function while you are on the intravenous fluids. Typically, your symptoms and the kidney function should begin to recover over a couple of days, and the urine should begin to clear up. In some patients, however, the kidneys can develop injury to the point where dialysis might become necessary. Remember, dialysis is a supportive therapy. It does not treat the kidney failure per se; it only replaces the kidney function. If the kidneys are going to recover, they will do so on their own, and all that the patient and physician can do is to give them a supportive environment. Rarely, the patient could become dialysis-dependent for life. 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015;51(6):793-810. doi:10.1002/mus.24606 Kim J, Lee J, Kim S, Ryu HY, Cha KS, Sung DJ. Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review. Journal of Sport and Health Science. 2016;5(3):324-333. doi:10.1016/j.jshs.2015.01.012 Thongprayoon C, Petnak T, Kanduri SR, et al. Impact of rhabdomyolysis on outcomes of hospitalizations for heat stroke in the United States. Hospital Practice. 2020;48(5):276-281. doi:10.1080/21548331.2020.1792214 Zhang MH. Rhabdomyolosis and its pathogenesis. World Journal of Emergency Medicine. 2012;3(1):11. doi:10.5847/wjem.j.issn.1920-8642.2012.01.002 Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: Pathogenesis, diagnosis, and treatment. Ochsner J. 2015;15(1):58-69. Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: A practice management guideline from the Eastern Association for the Surgery of Trauma. The American Journal of Surgery. 2022; 23 (1). doi:10.1016/j.amjsurg.2021.11.022 By Veeraish Chauhan, MD Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit