Abstract
Rhabdomyolysis is a state of muscle necrosis with the hallmark being elevated creatine kinase that may cause acute kidney injury with serious consequences. It happens in many clinical settings. We sought to investigate all cases of rhabdomyolysis admitted to an acute hospital in Ireland over one calendar year. All cases of rhabdomyolysis admitted to a tertiary hospital over a 12-month period were reviewed. It was defined as serum creatine kinase greater than five times upper limit normal. The incidence, presenting characteristics and clinical outcomes, was collected from electronic records, electronic consult system and discharge summaries. Rhabdomyolysis was observed in 306 (1.7%) of all 18,297 admissions. It was seen most commonly in the setting of acute coronary syndrome (19.6%), post-operative state (18.0%), long-term confinement in the same position (16.3%), infection (9.2%) and seizures (6.5%). Overall mortality in this group was 16%. Acute kidney injury occurred in 43% of patients. Those with severe acute kidney injury (stage 3) had a mortality of 50%. Length of stay was significantly prolonged in the presence of acute kidney injury (p < 0.001). Surprisingly, in 44% of those with acute kidney injury, nephrology advice was not requested. Rhabdomyolysis is a common and a serious clinical condition across many specialties in an acute hospital that would likely benefit from nephrology involvement should acute kidney injury supervene.
References
Torres PA, Helmstetter JA, Kaye AM, Kaye AD (2015) Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J 15:58–69
Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M (2014) Rhabdomyolysis: review of the literature. Neuromuscul Disord 24:651–659
Bywaters EG (1990) 50 years on: the crush syndrome. BMJ 301:1412–1415
Zhang MH (2012) Rhabdomyolosis and its pathogenesis. World J Emerg Med 3:11–15
Bosch X, Poch E, Grau JM (2009) Rhabdomyolysis and acute kidney injury. N Engl J Med 361:62–72
Ward MM (1988) Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 148:1553–1557
de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP (2003) Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 29:1121–1125
Melli G, Chaudhry V, Cornblath DR (2005) Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 84:377–385
Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar MM, Rahmati F, Motamedi M, Najafi I (2016) The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol 20:153–161
Gabow PA, Kaehny WD, Kelleher SP (1982) The spectrum of rhabdomyolysis. Medicine (Baltimore) 61:141–152
Premru V, Kovac J, Ponikvar R (2013) Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury. Ther Apher Dial 17:391–395
Gelpi-Hammerschmidt F, Tinay I, Allard CB, Su LM, Preston MA, Trinh QD, Kibel AS, Wang Y, Chung BI, Chang SL (2016) The contemporary incidence and sequelae of rhabdomyolysis following extirpative renal surgery: a population based analysis. J Urol 195:399–405
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval was granted by the Institutional Review Board.
Conflicts of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
McKenna, M.C., Kelly, M., Boran, G. et al. Spectrum of rhabdomyolysis in an acute hospital. Ir J Med Sci 188, 1423–1426 (2019). https://doi.org/10.1007/s11845-019-01968-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-019-01968-y