Rhabdomyolysis as a cause of acute renal failure.

Traumatic rhabdomyolysis with myoglobinuria and renal failure has been recognized for many years. In the past decade, rhabdomyolysis has been found to have various nontraumatic causes as well, including genetic conditions, metabolic disorders, exercise, toxins, infections, and drugs. Characteristic clinical and laboratory features include muscle tenderness, pigmenturia with urine that is orthotoluidine (Hematest) positive, greatly elevated creatine kinase levels, and often, renal failure. Treatment consists of fluid replacement and establishment of adequate urine flow early. If acute renal failure occurs, it should be treated appropriately. Particularly important are reversal of hyperkalemia and withholding of calcium during the hypocalcemic phase to prevent exacerbation of hypercalcemia later.