Medical Description

In the United States, Rhabdomyolysis accounts for an estimated 8-15 percent of cases of acute renal failure.

Rhabdomyolysis is a devastating muscle disorder that can result from a variety of diseases, traumas or toxic insults to a person’s skeletal muscles. Rhabdomyolysis damages the integrity of the thin membranes that enclose and protect skeletal muscle fibers. When these membranes, known as sarcolemma, break down, they release potentially toxic muscle cell components called myoglobins into the bloodstream.

Myoglobins are oxygen-binding protein pigments found in the skeletal muscle. When myoglobin is released into the bloodstream, it is then filtered out of the bloodstream by the kidneys. Too much myoglobin may limit the amount of oxygen getting to the interior tube-like structures of the kidney, killing the cells inside the tubes and leading to a condition known as acute tubular necrosis. Essentially, rhabdomyolysis leads to kidney cell death and eventual kidney failure.

Myoglobin also breaks down into other potentially toxic compounds that may also cause kidney failure. Necrotic, or dead, skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the relative fluid volume of the body and leading to shock and reduced blood flow to the kidneys. This can result in potential life-threatening complications including:

• leads to death in over 30% of patients
• hyperkalaemia, an abnormally high concentration of potassium in the blood which can cause muscle weakness and paralysis
• disseminated intravascular coagulation, a blood disorder leading to extensive hemorrhaging and a failure of the entire circulatory system
• compartment syndrome, in which the fluid volume inside the cells lowers cell pressure to the extent that blood flow actually stops
• cardiac arrest

Symptoms

• abnormal urine color (dark, red, or cola colored)
• muscle tenderness
• weakness of the affected muscle(s)
• generalized weakness
• muscle stiffness or aching (myalgia)
• unintentional weight gain
• seizures
• joint pain
• fatigue
• malaise

General Information

The US Food and Drug Administration (FDA) has associated a group of drugs called statins, which are used to lower blood cholesterol, to Rhabdomyolysis. The drugs work by blocking a substance needed to make cholesterol and also help the body reabsorb accumulated cholesterol to prevent further blood vessel blockages.

The class of statin drugs includes Crestor, Lipitor, Zocor and Pravachol.

Sources: “Rhabdomyolysis,” Medline Encyclopedia, September 13, 2005; “Rosuvastatin (marketed as Crestor),” US Food and Drug Administration Alert, March 2005.

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