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Colegio de Medicina Interna de México.

2007, Number 1

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Med Int Mex 2007; 23 (1)

Rhabdomyolysis and acute renal failure

Duarte MJ, Díaz MS, Lee ECVE

Language: Spanish
References: 53
Page: 47-58
PDF size: 207.95 Kb.


ABSTRACT

Rhabdomyolysis is the liberation of components of injured skeletal muscle into the circulation. There are many etiologies of rhabdomyolysis. Direct compression of muscle leading to a local crush injury is the most common mechanism of traumatic rhabdomyolysis. Compression causes muscle ischemia, as tissue pressure rises to a level that exceeds capillary perfusion pressure. When the compression is relieved, the muscle tissue is reperfused. Muscle ischemia followed by reperfusion (ischemia–reperfusion–injury) represents the fundamental pathophysiologic mechanism of rhabdomyolysis. Acute alcohol intoxication with subsequent immobility and coma is the most common etiologic factor of direct muscle compression. Other etiologies are infectious, metabolic and genetics. Dark, tea-colored urine that is dipstick positive for blood despite the absence of red blood cells on microscopy is suggestive of myoglobinuria and rhabdomyolysis. The quickest and least expensive screening test for rhabdomyolysis is the serum CK level. Acute renal failure is one of its most serious consequences and occurs in 4 to 33% of cases, carrying with it a mortality rate of 3 to 50%. The vigorous fluid resuscitation is the cornerstone of the treatment.


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