Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Review

Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice

Authors: Luis O. Chavez, Monica Leon, Sharon Einav, Joseph Varon

Published in: Critical Care | Issue 1/2016

Login to get access

Abstract

Background

Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis.

Methods

A systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics.

Results

The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis.

Conclusion

Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
Literature
1.
2.
Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med. 2007;19(2):90–100.CrossRef
3.
4.
Landau ME, Kenney K, Deuster P, Campbell W. Exertional rhabdomyolysis: a clinical review with a focus on genetic influences. J Clin Neuromuscul Dis. 2012;13(3):122–36.CrossRefPubMed
5.
Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23(8):1333–40.CrossRefPubMed
6.
Iwere RB, Hewitt J. Myopathy in older people receiving statin therapy: a systematic review and meta-analysis. Br J Clin Pharmacol. 2015;80(3):363–71.CrossRefPubMed
7.
Mehmet SS, Lameire N, Biesen WV, Vanholder R. Disaster nephrology: a new concept for an old problem. Clin Kidney J. 2015;8:300–9.CrossRef
8.
9.
Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009;361(1):62–72.CrossRefPubMed
10.
Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med. 2008;19(8):568–74.CrossRefPubMed
11.
Ron D, Taitelman U, Michaelson M, Bar-Joseph G, Bursztein S, Better OS. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med. 1984;144(2):277–80.CrossRefPubMed
12.
Sheng ZY. Medical support in the Tangshan earthquake: a review of the management of mass casualties and certain major injuries. J Trauma. 1987;27:1130–5.CrossRefPubMed
13.
Brown C, Rhee P, Chan L, Evans K, Demetriades D, Velmahos GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma. 2004;56(6):1191–6.CrossRefPubMed
14.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005;84:377–85.CrossRef
15.
Sever MS, Vanholder R, Ashkenazi L, Becker G, Better O, Covic A, et al. Recommendation for the management of crush victims in mass disasters. Nephrol Dial Transplant. 2012;27 Suppl 1:i1–i67.CrossRefPubMed
16.
Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics. 2006;118:2119–25.CrossRefPubMed
17.
Lagandre S, Arnalsteen L, Vallet B, Robin E, Jany T, Onraed B, et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg. 2006;16(10):1365–70.CrossRefPubMed
18.
de Oliveira LD, Diniz MT, de Fatima HS, Diniz M, Savassi-Rocha AL, Camargos ST, et al. Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study. Obes Surg. 2009;19(8):1102–7.CrossRefPubMed
19.
Linares LA, Golomb BA, Jaojoco JA, Sikand H, Phillips PS. The modern spectrum of rhabdomyolysis: drug toxicity revealed by creatine kinase screening. Curr Drug Saf. 2009;4(3):181–7.CrossRefPubMed
20.
Youssef T, Abd-Elaal L, Zakaria G, Haasheesh M. Bariatric surgery: rhabdomyolysis after open Roux-en-Y gastric bypass: a prospective study. Int J Surg. 2010;8(6):484–8.CrossRefPubMed
21.
Alpers JP, Jones Jr LK. Natural history of exertional rhabdomyolysis: a population-based analysis. Muscle Nerve. 2010;42(4):487–91.CrossRefPubMed
22.
Bache SE, Taggart I, Gilhooly C. Late-onset rhabdomyolysis in burn patients in the intensive care unit. Burns. 2011;37(7):1241–7.CrossRefPubMed
23.
Oshima Y. Characteristics of drugs-associated rhabdomyolysis: analysis of 8,610 cases reported to the U.S. Food and Drug administration. Intern Med. 2011;50(8):845–53.CrossRefPubMed
24.
Herraez Garcia J, Torracchi Carrasco AM, Antoli-Royo AC, et al. Rhabdomyolysis: a descriptive study of 449 patients. Med Clin (Barc). 2012;139(6):238–42.CrossRef
25.
El-Abdellati E, Eyselbergs M, Sirimsi H, Hoof VV, Wouters K, Verbrugghe W, et al. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care. 2013;3:8. doi:10.​1186/​2110-5820-3-8.CrossRefPubMedPubMedCentral
26.
Rodriguez E, Soler MJ, Rap O, Barrios C, Orfila MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS One. 2013;8(12):e82992.CrossRefPubMedPubMedCentral
27.
Chen CY, Lin YR, Zhao LL, Yang WC, Chang YJ, Wu KH, et al. Clinical Spectrum of rhabdomyolysis presented to pediatric emergency department. BMC Pediatr. 2013;13:134.CrossRefPubMedPubMedCentral
28.
Talving P, Karaanos E, Skiada D, Lam L, Teixeira P, Inaba K, et al. Relationship of creatine kinase elevation and acute kidney injury in pediatric trauma patients. J Trauma Acute Care Surg. 2013;74(3):912–6.CrossRefPubMed
29.
Grunau BE, Pourvali R, Wiens MO, Levin A, Li J, Grafstein E, et al. Characteritics and thirty-day outcomes of emergency department patients with elevated creatine kinase. Acad Emerg Med. 2014;21(6):631–6.CrossRefPubMed
30.
van Staa TP, Carr DF, O’Meara H, McCann G, Pirmohamed M. Predictors and outcomes of increases in creatine phosphokinase concentrations or rhabdomyolysis risk during statin treatment. Br J Clin Pharmacol. 2014;78(3):649–59.CrossRefPubMedPubMedCentral
31.
Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav AL, et al. Rhabdomyolysis after major urologic surgery: epidemiology, risk factors, and outcomes. Urology. 2015;85(6):1328–32.CrossRefPubMed
32.
Antons KA, Williams CD, Baker SK, Phillips PS. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med. 2006;119(5):400–9.CrossRefPubMed
33.
Harper CR, Jacobson TA. The broad spectrum of statin myopathy: from myalgia to rhabdomyolysis. Curr Opin Lipidol. 2007;18(4):401–8.CrossRefPubMed
34.
Iraj N, Saeed S, Mostafa H, Houshang S, Ali S, Farin RF, et al. Prophylactic fluid therapy in crushed victims of Bam earthquake. Am J Emerg Med. 2011;29:738–42.CrossRefPubMed
35.
36.
37.
Torres PA, Helmestetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J. 2014;15(1):58–69.
38.
Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24(8):651–9.CrossRefPubMed
39.
40.
41.
Norata GD, Tibolla G, Catapano AL. Statins and skeletal muscles toxicity: from clinical trials to everyday practice. Pharmacol Res. 2014;88:107–13.CrossRefPubMed
42.
43.
44.
Shimada M, Dass B, Ejaz AA. Paradigm shift in the role of uric acid in acute kidney injury. Semin Nephrol. 2011;31(5):453–8.CrossRefPubMed
45.
Firwana BM, Hasan R, Hasan N, Alahdab F, Alnahhas I, Hasan S, et al. Tumor lysis syndrome: a systematic review of case series and case reports. Postgrad Med. 2012;124(2):92–101.CrossRefPubMed
46.
de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP. Serum creatine kinase as predictor of clinical course in rhabdomyolysis a 5-year intensive care survey. Intensive Care Med. 2003;29(7):1121–25.CrossRefPubMed
47.
Baeza-Trinidad R, Brea-Hernando A, Morera-Rodriguez S, Brito-Diaz Y, Sanchez-Hernandez S, El Bikri L, et al. Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis. Intern Med J. 2015;45(11):1173–8.CrossRefPubMed
48.
Premru V, Kovač J, Ponikvar R. Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury. Ther Apher Dial. 2013;17:391–5.CrossRefPubMed
49.
Rodriguez-Capote K, Balion CM, Hill SA, Cleve R, Yang L, El Sharif A. Utility of urine myoglobin for the prediction of acute renal failure in patients with suspected rhabdomyolysis: a systematic review. Clin Chem. 2009;55(12):2190–7.CrossRefPubMed
50.
Thomas ME, Blaine C, Dawnay A, Devonald MA, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney Int. 2015;87(1):62–73.CrossRefPubMed
51.
Talaie H, Emam-Hadi M, Panahandeh R, Hassanian-Moghaddam H, Abdollahi M. On the mechanisms underlying poisoning-induced rhabdomyolysis and acute renal failure. Toxicol Mech Methods. 2008;18:585–8.CrossRefPubMed
52.
Cervellin G, COmelli I, Lippi G. Rhabdomolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med. 2010;48(6):749–56.CrossRefPubMed
53.
McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013;173(19):1821–8.CrossRefPubMed
54.
Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother. 2013;47(1):90–105.CrossRefPubMed
55.
Altintepe L, Guney I, Tonbul Z, Turk S, Mazi M, Agca E, et al. Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya. Ren Fail. 2007;29(6):737–41.CrossRefPubMed
56.
Cho YS, Lim H, Kim SH. Comparison of lactated Ringer’s solution and 0.9 % saline in the treatment of rhabdomyoysis induced by doxylamine intoxication. Emerg Med J. 2007;24:276–80.CrossRefPubMedPubMedCentral
57.
Zepeda-Orozco D, Ault BH, Jones DP. Factors associated with acute renal failure in children with rhabdomyolysis. Pedatr Nephrol. 2008;23:2281–4.CrossRef
58.
Sanadgol H, Najafi I, Rajabi Vahid M, Hossini M, Ghafari A. Fluid therapy in pediatric victims of the 2003 Bam, Iran earthquake. Prehosp Disaster Med. 2009;24:448–52.CrossRefPubMed
59.
60.
Zeng X, Zhang L, Wu T, Fu P. Continuous renal replacement therapy (CRRT) for rhabdomyolysis. Cochrane Database Syst Rev. 2014;6:CD008566.PubMed
61.
Berend K, de Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med. 2015;372(2):195.PubMed
62.
Bragadottir G, Redfors B, Ricksten SE. Mannitol increases renal blood flow and maintains filtration fraction and oxygenation in postoperative acute kidney injury: a prospective interventional study. Crit Care. 2012;16:R159.CrossRefPubMedPubMedCentral
63.
Sorrentino SA, Kielstein JT, Lukasz A, Sorrentino JN, Gohrbandt B, Haller H, et al. High permeability dialysis membrane allows effective removal of myoglobin in acute kidney injury resulting from rhabdomyolysis. Crit Care Med. 2011;39:184–6.CrossRefPubMed
64.
Heyne N, Guthoff M, Krieger J, Haap M, Häring HU. High cut-off renal replacement therapy for removal of myoglobin in severe rhabdomyolysis and acute kidney injury: a case series. Nephron Clin Pract. 2012;121:159–64.CrossRef
Metadata
Title
Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice
Authors
Luis O. Chavez
Monica Leon
Sharon Einav
Joseph Varon
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1314-5

Other articles of this Issue 1/2016

Critical Care 1/2016 Go to the issue

Letter

Stress ulcer prophylaxis in adult neurocritical care patients—no firm evidence for benefit or harm

Letter

Measurement of functional and morphodynamic neutrophil phenotypes in systemic inflammation and sepsis

Review

The role of neutrophils in immune dysfunction during severe inflammation

Letter

Improving the “urinary side” of acute kidney injury monitoring

Research

Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome

Research

Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis