Exertional Rhabdomyolysis Requiring Kidney Replacement Therapy in a Man with Sickle Cell Trait

Introduction: Sickle cell trait (SCT) is generally asymptomatic. Rarely, patients with SCT develop exertional rhabdomyolysis (ER) after strenuous exercise. ER can lead to compartment syndrome, DIC, and myoglobinuric AKI. We present a case of acute oliguric renal failure requiring renal replacement therapy (RRT) secondary to ER in a patient with previously unknown SCT. Case Description: After completion of police academy training, a 39 y/o black man developed bilateral leg weakness and muscle spasms. Exercise consisted of push-ups, sit-ups, and a one-mile run. He had no significant PMH, no FH of SS disease or trait, and took no medications. Exam was notable for weakness and diffuse muscle tenderness. Initial laboratory findings included serum creatinine 2.0 mg/dL, lactic acid 8.8 mmol/L, and creatine kinase (CK) 1,516 U/L. Urine was brown (Figure) and urinalysis had 4+ blood with 1 RBC/hpf. Urine drug screen was negative. His CK level peaked at 565,070 U/L and he was started on CVVHD for worsening acidosis. Work-up had normal TFTs and negative autoimmune and glycogen storage disease panels. Hemoglobin electrophoresis showed 35.1% hemoglobin S, consistent with SCT. He remained on RRT for 18 days. He ultimately had full recovery of renal function. Discussion: SCT may be present in up to 300 million patients worldwide and is typically asymptomatic; ER is a very rare but established condition associated with SCT. We present a patient who completed relatively low-intensity exercise, yet still developed ER requiring RRT. Our patient developed ER because of a mandated training required for policy academy admission. Screening protocols for SCT in those whose careers involve heavy exercise, such as police work or the armed forces, can be seen as discriminatory. We conclude that further study is required in patients with SCT who develop ER to determine if secondary factors impact the risk of ER.Tea colored urine on day one of hospital admission.