Rhabdomyolysis (RM) is a condition that is characterized by the disturbance of skeletal muscles following the release of intracellular components into the extracellular space. The most frequent etiologies of rhabdomyolysis are trauma, immobilization, sepsis, and surgery. Clinical manifestations vary based on the condition’s specific cause and range in severity from elevated myoglobin and creatine kinase lab values to life-threatening electrolyte disruptions and organ dysfunction (Yang et al., 2020).
Acute kidney injury (AKI) is a common complication of rhabdomyolysis. The pathogenesis of AKI in rhabdomyolysis includes tubular obstruction caused by myoglobin, myoglobin cytotoxicity by lipid peroxidation, and the production of reactive oxygen species. Capillary damage is caused by the leakage of intracellular components into the circulation. This leads to edema, secondary hypovolemia, decreased renal blood flow, and eventually reduced renal function (Yang et al., 2020).
Elevated serum creatine kinase, acute kidney injury, acute tubular injury, and myoglobin casts in the tubular lumen are the hallmark signs of rhabdomyolysis induced acute kidney injury (RIAKI). Myoglobin is released from injured muscles into the circulation, is endocytosed by tubular cells, and induces pathways of pro-oxidant injury both directly and via its breakdown products. A well-established biomarker of oxidative stress in RIAKI is 4-HNE which is one of the most bioactive products of lipid peroxidation (Grivei et al., 2020).
Acute kidney injury directly increases the mortality rate of patients with rhabdomyolysis. Early evaluation, diagnosis, and treatment are vital for preventing AKI and improved patient prognosis (Yang et al., 2020).
References
Grivei, A., Giuliani, K. T. K., Wang, X., Ungerer, J., Francis, L., Hepburn, K., John, G. T., Gois, P. F. H., Kassianos, A. J., & Healy, H. (2020). Oxidative stress and inflammasome activation in human rhabdomyolysis-induced acute kidney injury. Free Radical Biology and Medicine, 160, 690–695. https://doi.org/10.1016/j.freeradbiomed.2020.09.011
Yang, J., Zhou, J., Wang, X., Wang, S., Tang, Y., & Yang, L. (2020). Risk factors for severe acute kidney injury among patients with rhabdomyolysis. BMC Nephrology, 21(1). https://doi.org/10.1186/s12882-020-02104-0
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