Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.

Pathology - Myoglobinuria (nephrotoxin) causes renal failure by tubular cell necrosis

Causes

• seizure
• collapse/coma (e.g. elderly patients collapses at home, found 8 hours later)
• ecstasy
• crush injury
• McArdle's syndrome
• drugs: statins (especially if co-prescribed with clarithromycin)

PC

Classic traid:

• Dark urine
• generalised weakness
• myalgia

Investigations

• acute kidney injury with disproportionately raised creatinine
• elevated creatine kinase (CK) - severely, 5x the normal levels
  • Elevations of CK that are 'only' 2-4 times that of normal are not supportive of a diagnosis of rhabdomyolysis and suggest another underlying pathophysiology