What is the treatment for rhabdomyolysis (muscle breakdown) leading to glomerulonephritis (inflammation of the kidneys)?

Treatment of Rhabdomyolysis-Induced Glomerulonephritis

The primary treatment for rhabdomyolysis-induced glomerulonephritis consists of aggressive intravenous fluid resuscitation with normal saline to maintain a urine output of at least 300 mL/hour, along with supportive care to prevent and manage acute kidney injury. 1

Initial Management

• Begin aggressive intravenous fluid resuscitation with normal saline immediately upon diagnosis to dilute nephrotoxic substances and maintain adequate renal perfusion 2, 1
• Target urine output of 300 mL/hour to prevent tubular obstruction and renal damage 1
• Monitor and correct electrolyte abnormalities, particularly hyperkalemia, which can be life-threatening in rhabdomyolysis 2, 3
• Restrict dietary sodium to <2.0 g/day to help manage fluid overload and hypertension that may develop 4

Supportive Care

• Use diuretics (preferably loop diuretics) once euvolemia/hypervolemia is achieved to maintain diuresis 2
• Monitor for adverse effects of diuretics including hyponatremia, hypokalemia, GFR reduction, and volume depletion 4
• Control hypertension with ACE inhibitors or ARBs at maximally tolerated doses as first-line therapy 4
• Target systolic blood pressure <120 mmHg in adult patients using standardized office BP measurement 4

Monitoring Parameters

• Regularly assess creatine kinase (CK) levels to track muscle breakdown severity 3
• Monitor kidney function through serum creatinine and estimated GFR 4
• Assess urine output hourly and maintain urine pH around 6.5 5
• Evaluate for a ≥40% decline in eGFR from baseline, which serves as a surrogate outcome measure for kidney failure 4

Advanced Interventions

• Consider renal replacement therapy (dialysis) for severe cases with:

  • Refractory hyperkalemia
  • Severe metabolic acidosis
  • Volume overload unresponsive to diuretics
  • Uremic symptoms 2, 1

• Early initiation of renal replacement therapy may improve outcomes in severe cases 2

Special Considerations

• Identify and treat the underlying cause of rhabdomyolysis (e.g., trauma, toxins, infections, seizures) 6, 3
• Avoid nephrotoxic medications that may worsen kidney injury 1
• For recurrent cases of rhabdomyolysis, consider evaluation for underlying myopathy or metabolic muscle defects 3

Controversial Interventions

• Urinary alkalinization with bicarbonate administration:

  • Has traditionally been recommended to prevent myoglobin precipitation
  • Current evidence does not strongly support improved outcomes 2, 1
  • May be considered on a case-by-case basis but is not routinely recommended

• Mannitol:

  • Previously suggested to promote osmotic diuresis
  • Lacks strong evidence for improved outcomes 1
  • Not recommended as routine therapy

Prognosis

• With appropriate and timely treatment, mortality from rhabdomyolysis is relatively low (approximately 3.4%) 3
• Acute kidney injury occurs in approximately 46% of hospitalized patients with rhabdomyolysis 3
• Multiple contributing factors to rhabdomyolysis increase the risk of developing acute kidney injury 3

Prevention of Recurrence

• For patients with a history of rhabdomyolysis, provide education on:
  • Adequate hydration during exercise or illness 6
  • Avoidance of identified triggers (medications, toxins, excessive exertion) 6, 3
  • Recognition of early symptoms requiring medical attention 1