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“Kidney failure” is something that everyone fears and does not want to happen to themselves or their loved ones. This makes everyone try to take care of themselves to avoid the risk of kidney disease. However, one fact that many people may not have known before is that even if we do not have kidney disease, we can still experience kidney failure if the body is in a “rhabdomyolysis” condition. For this reason, understanding rhabdomyolysis is important and should not be overlooked, so that we can take care of ourselves and those close to us to be as safe as possible from kidney failure.
<h2>What is rhabdomyolysis and why can it cause kidney failure?</h2>
Most of the muscles in our body are “skeletal muscles”, which make up about 50% of all muscles. Examples of skeletal muscles in the body include the muscles of the arms, legs, torso, and other parts used for movement. When an event causes these muscles to enter a “rhabdomyolysis” state, various chemicals within the muscles are released into the bloodstream in large amounts, which affects the kidneys and can eventually lead to kidney failure.
<h2>What causes rhabdomyolysis leading to kidney failure?</h2>
The main causes that lead to rhabdomyolysis can be divided into 3 groups:
<ol>
<li>Accidents, such as car crashes where the injured person is trapped inside the vehicle for a long time. Some muscles may be injured and compressed for several hours without movement, which can cause rhabdomyolysis.</li>
<li>Excessive exercise when the body is not ready or fit, increasing the risk of rhabdomyolysis. Exercising in hot weather can worsen this because when the temperature rises, the body cannot properly dissipate heat. The increasing body temperature can cause rhabdomyolysis and potentially kidney failure.</li>
<li>Other causes such as heavy alcohol consumption or use of certain medications like cholesterol-lowering drugs, as well as illicit drugs like cocaine and methamphetamine. These substances have been reported to cause rhabdomyolysis. Infections, whether viral or bacterial, including influenza and COVID-19 viruses, can also cause rhabdomyolysis.</li>
</ol>
<h2>What symptoms suggest rhabdomyolysis?</h2>
Rhabdomyolysis can range in severity from no symptoms at all to very severe symptoms that can be life-threatening due to acute kidney failure. The warning signs of rhabdomyolysis that can be observed include:
<ul>
<li>Severe muscle pain in the upper arms, thighs, shoulders, or back</li>
<li>Brown or even red-colored urine due to chemicals from the damaged muscles leaking into the bloodstream and being filtered by the kidneys, causing the urine to change to a brownish-red color</li>
<li>An important warning sign of kidney failure is a noticeable decrease in urine output, which does not improve even after drinking plenty of water and remains abnormally low</li>
</ul>
<h2>How is rhabdomyolysis with kidney failure diagnosed and treated?</h2>
Initially, doctors need to diagnose the cause of rhabdomyolysis in the patient to address the root of the problem. For example, if the cause is medication, the medication must be stopped immediately. After stopping the cause, treatment involves correcting dehydration by administering intravenous fluids to increase blood circulation and flush out the pigments from the damaged muscle chemicals. If these pigments precipitate in the kidney tubules, they can cause kidney failure.
However, if rhabdomyolysis has progressed to kidney failure, dialysis treatment is necessary. If left untreated, complications such as abnormal potassium levels can cause irregular heartbeats, or reduced urine output can lead to pulmonary edema, which can be life-threatening.
<h2>How to take care of yourself to stay safe from rhabdomyolysis</h2>
Simple guidelines to take care of yourself and avoid rhabdomyolysis include:
<ol>
<li>Be as careful as possible to reduce the risk of accidents that may cause rhabdomyolysis</li>
<li>Avoid drinking alcoholic beverages, especially before exercising</li>
<li>Do not overexert yourself during exercise; ensure you have trained enough for intense physical activity</li>
<li>Do not let your body become dehydrated, as dehydration increases the risk of rhabdomyolysis</li>
<li>Replenish potassium during heavy exercise by eating bananas and drinking electrolyte drinks. Potassium is lost through sweat, and the more you sweat, the more potassium you lose. Potassium deficiency lowers oxygen levels in the blood, reducing blood flow to muscles, causing cramps and increasing the risk of rhabdomyolysis</li>
</ol>
&nbsp;
Older adults are at higher risk of rhabdomyolysis, but young people who do not take good care of themselves or are careless in their lifestyle can also be at risk, especially when exercising intensely without proper preparation, drinking too little water, and becoming dehydrated unknowingly. This can lead to rhabdomyolysis and acute kidney failure.
Therefore, taking good care of yourself, exercising appropriately, drinking enough water, avoiding alcohol, and not taking unnecessary supplements are important. Also, regularly observe any abnormal symptoms in your body and monitor your urine for any unusual changes. If you notice any suspicious signs of rhabdomyolysis, promptly consult a doctor for diagnosis and treatment.


Dr. San Treewitayapoom 
Internist, Head of Kidney Disease Center, Specialist in Nephrology 
Dialysis Center, Phyathai 3 Hospital

When an event causes skeletal muscles to enter a state of muscle necrosis, various chemicals within the muscles are released into the bloodstream in large amounts, affecting the kidneys and eventually leading to kidney failure.

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Did you know? If the muscle dies, it can lead to kidney failure.

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