Acute Kidney Injury due to Rhabdomyolysis: A Case Series

Rhabdomyolysis (RM) is a clinical syndrome characterized by injury to skeletal muscle fibers with disruption and release of myoglobin, intracellular proteins, and electrolytes.Life-threatening acute kidney injury is the most serious complication of RM.Our first case was an 80-year-old hypertensive and diabetic male.He presented with diarrhea, reduced urine output, and dark-colored urine.Our 2nd case was a 43-year-old male on bed rest, who developed severe lumbar and sacral pain following a fall.He consumed Nonsteroidal anti-inflammatory drugs (NSAIDs) for 2 days.Later he complained of dark brown urine.Magnetic resonance imaging (MRI) of the lumbosacral region revealed right paraspinal and iliopsoas swelling.In our 3rd case, a 22-year-old male gave a history of consuming NSAIDs for pain in both arms following exertion.On the third day, he complained of increased pain and dark brown urine.Our fourth case, a 40-year-old male was brought to the hospital in a drowsy state.Ultrasound abdomen revealed a liver span of 13.2 cm, and bright echotexture, the right kidney was 11.3 cm and the left kidney was 11.1 cm with bright echogenicity.Our 5th case a 37-year-old female was a case of chronic kidney disease, who had undergone a live related ABO compatible renal transplant.She came for a routine Out patient Department (OPD) follow-up with a history of pain abdomen, diarrhea, and diffuse, aches.Her abdomen revealed that the transplanted kidney was 10.3 cm in size with bright echogenicity.All 5 cases were diagnosed as RM and acute kidney injury due to different etiologies and were managed accordingly with IV fluids, intermittent hemodialysis, phosphorus replacements, and vitamin D analogs as applicable.All the cases gradually recovered, and were discharged with advice to follow-up on an OPD basis.To summarize, RM can have multiple etiologies, and acute kidney injury is the common manifestation of RM.Timely initiation of renal replacement therapy generally leads to a favorable outcome.This case series is an important learning point for physicians to consider RM as a differential diagnosis in acute kidney injury.