Abstract: PUB414
Recurrent Exertional Rhabdomyolysis
Session Information
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Author
- Zhao, Jinhua, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
Introduction
Rhabdomyolysis (Rhabdo) was first described by Larrey in 1812. The original “crush injury syndrome” was described by Bywater et al in 1941. Myoglobin was identified as the offending agent for AKI by Bywater et al in 1943. The prevalence of exertional rhabdo is ~12,000 cases annually in US. It is well described among athletes and military personnel, but may occur in anybody after unaccustomed exercise.
Case Description
32 year-old male, a runner has "dark red urine" after each marathon or training. His urine (Fig. 1) appears to be heme loaded, it clears up in one day. It's a problem of 2 years. He also has sports related mild proteinuria. No myalgia. No family history.
Meds: lisinopril 2.5mg, loratadine 10mg, omeprozole 20mg daily
AM labs after the morning run:
UA: dark brown color, protein 100mg/dL, Heme >1.0 mg/dL, RBC <1/hpf.
Renal panel: Na 135, K 4.2, Cr 1.0.
Myoglobin-Urine 3574 H Ng/Ml (ref 0 - 13)
Myoglobin-Serum 72 Ng/Ml (ref 28 - 72)
CK 484 H U/L (ref 46 – 171)
Discussion
Fig.2 showed the common cause of rhabdomyolysis (Ref 1):
Diagnosis of rhabdo does not dependent on the presence of myoglobinemia and myoglobinuria as they are quickly cleared. CK >1,000 U/L is concerning for rhabdo without exercise, but has been frequently observed without apparent health consequences (Ref 2) with exercise.
Exertional rhabdo may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. The genetic testings for this patient are ordered and will be shared when available.
NEJM 2009, 361:6272