What Is Rhabdomyolysis?

Rhabdomyolysis syndrome refers to a series of hereditary or acquired diseases that affect rhabdomyocellular membranes, membrane channels, and their energy supply. Rhabdomyolysis, cell membrane integrity changes, and cell contents (such as myoglobin, Small molecule substances, etc.) are leaked, and are often accompanied by acute renal failure and metabolic disorders.

Basic Information

Visiting department

Internal medicine

Common locations

Renal striated muscle

Common causes

Excessive exercise, muscle crush injury, ischemia, metabolic disorders, extreme body temperature, drugs, poisons, autoimmunity, infections, etc.

Common symptoms

Muscle pain, tenderness, swelling and weakness, fever, general weakness, oliguria, anuria, etc.

Causes of rhabdomyolysis syndrome

The cause of striated muscle is very complicated. Some people in foreign countries have pointed out that there are more than 190 kinds of acquired causes, and more than 40 kinds of hereditary-related causes. Common causes include excessive exercise, muscle crush injury, ischemia, and metabolic disorders (hypokalemia). , Hypothyroidism, diabetic ketoacidosis), extreme body temperature (high fever, low fever), drugs, poisons, autoimmunity, infection, etc. Common genetic factors such as: deficiency of creatine phosphorylase, lack of carnitine soft acyltransferase II and other causes. The pathophysiological mechanisms include ischemic injury and ATP depletion, impaired sarcoplasmic reticulum calcium regulation, hypokalemia, and tissue oxidative stress. Among them, the direct damage of myoglobin to the kidney is the most direct cause of acute renal failure.

When rhabdomyolysis causes acute renal failure, the pathology is acute tubular necrosis; mechanism: renal tubular obstruction; tubular oxide damage; renal ischemia (including vasoconstriction and hypovolemia).

Clinical manifestations of rhabdomyolysis syndrome

Visible muscle pain such as muscle pain, tenderness, swelling, and weakness, as well as inflammatory reactions such as fever, general weakness, increased white blood cells and / or neutrophils, urine appearance: brown or red wine color Pee. About 30% of this disease will cause acute renal failure. When acute renal failure is more severe, the manifestations of oliguria, anuria and other azotemia can be seen.

Rhabdomyolysis syndrome

Blood test

Biochemical examination showed increased serum muscle enzymes and other muscle enzymes (creatine kinase, transaminase, aldolase, lactate dehydrogenase, etc.); creatinine, urea nitrogen, uric acid levels increased, high potassium, high phosphorus, metabolic acidosis; may be accompanied by Blood system abnormalities such as thrombocytopenia and diffuse intravascular coagulation; myoglobinemia.

2. Urine test

Myoglobinuria, urine routine: often proteinuria; urinary sediment: no red blood cells or a small number of red blood cells, granular casts, increased myoglobin in urine, excretion of dicarboxylic acid in urine.

3. Muscle examination

(1) Bone 99TcMDP imaging shows high muscle uptake.

(2) MRI showed that the affected muscles were swollen and the T1 and T2 phases were high signal.

(3) Myocardial injury in the affected area of EMG.

4. ECG

Focus on examining the damage of hyperkalemia to myocardium.

Diagnosis of rhabdomyolysis syndrome

Confirmed diagnosis: For a clear cause, it is not difficult to diagnose based on the above clinical and laboratory characteristics.

Highly doubtful

(1) Have a typical medical history (including suspicious etiology, muscle performance and changes in urine color);

(2) There is "blood" in urine routine, but there are no red blood cells or a small amount of red blood cells on microscopy;

(3) Serum muscle enzyme is 5 times higher than normal, usually creatine kinase (CK)> 10000 U / L, lactate dehydrogenase, etc. are also increased, but there is no obvious heart disease or isoenzyme is also elevated suggesting skeletal muscle origin .

2. Myoglobin determination depends on blood or urine

(1) Immunochemical methods are the most sensitive.

(2) Normal level of radioimmunoassay: hemoglobin is 3 80ng / ml, urine is 3 20ng / ml.

(3) The urine myoglobin concentration is 250ug / ml (corresponding to about 100g muscle damage), then the urine color changes significantly.

(4) In some cases, increased myoglobin in blood or urine cannot be detected in time, because myoglobin is released early after rhabdomyolysis and cleared quickly when the kidney function is normal, that is, subclinical rhabdomyolysis.

Differential diagnosis of rhabdomyolysis syndrome

Care should be taken to distinguish it from other diseases that cause muscle weakness. Such as: non-necrotic acute myopathy, severe disease myopathy, dermatomyositis, periodic paralysis, Guillain-Barr syndrome and other diseases.

Rhabdomyolysis syndrome treatment

Main purpose: to protect renal function.

1. Stabilize the patient's vital signs, pay attention to the monitoring of the amount of access;

2. Remove the causes of rhabdomyolysis; avoid aggravating the risk factors of rhabdomyolysis.

3. Prevention of acute tubular necrosis: volume resuscitation; alkaline urine; application of antioxidants to protect renal tubular cells; hemodialysis or hemofiltration: if acute renal failure has occurred, renal replacement therapy may be required until renal function restore.

4. Treatment of other complications.