From the Field to the Emergency Room: A Systematic Case-Level Review of Exertional Rhabdomyolysis and Acute Kidney Injury in Athletes

Exertional rhabdomyolysis is a potentially life-threatening syndrome caused by skeletal muscle breakdown with release of myoglobin and creatine kinase (CK) into the circulation. Clinical severity ranges from transient enzyme elevation to severe acute kidney injury (AKI) requiring renal replacement therapy (RRT). Although increasingly recognized, the published literature remains fragmented and largely descriptive. This review systematically aggregated case-level data to characterize biochemical severity and renal outcomes across different athlete populations and exertional contexts. PubMed, Embase, Scopus, and Google Scholar were searched through December 2025 for published cases of exertional rhabdomyolysis with reported renal outcomes. Case-level data were extracted for demographics, athlete type, CK and creatinine values, author-defined AKI, RRT requirement, myoglobinuria, and recovery status. 46 articles met inclusion criteria, contributing 65 patients. Most patients were male (n=59, 90.8%), with a median age of 24 years (interquartile range (IQR) 20-30). The median peak CK was 55,000 U/L (IQR 25,000-120,000). AKI occurred in 49 patients (75.4%), and RRT was required in 14 patients (21.5%). Myoglobinuria was documented in 58 patients (89.2%). Recreational athletes represented the largest subgroup (n=20, 30.8%), followed by students or school athletes (n=14, 21.5%), military or law-enforcement personnel (n=12, 18.5%), collegiate athletes (n=7, 10.8%), manual laborers or occupationally active individuals (n=6, 9.2%), professional athletes (n=3, 4.6%), and other or unknown exertional contexts (n=3, 4.6%). No deaths were reported, and complete renal recovery was documented in 62 patients (95.4%). Exertional rhabdomyolysis predominantly affects young, otherwise healthy men after unaccustomed or strenuous physical activity. Although AKI was common among published cases, survival and renal recovery were generally favorable. Standardized reporting of disease severity, AKI definitions, treatment strategies, and long-term renal outcomes is needed.