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Scientists at Boston's Brigham and Women's Hospital have created a new scoring system for predicting who is likely to need dialysis for kidney failure after rhabdomyolysis, a surprisingly common condition involving the breakdown of muscle tissue.

Rhabdomyolysis (rab-do-my-AH-lo-sis) is the potentially deadly condition you probably never heard of. Literally meaning "dissolving muscle," rhabdomyolysis involves the leakage of potentially toxic proteins from damaged muscle cells into the bloodstream.

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The kidneys work overtime to remove these protein-based toxins out of circulation but often work so hard that they fail, and dialysis is necessary to prolong life.

What Kinds of Conditions Cause Rhabdomyolysis?

Doctors first noticed that muscle injury could lead to kidney failure while treating soldiers who had suffered crush injuries during World War II. In the seventy-five years since the documentation of the first cases, physicians have come to realize that rhabdomyolysis is multifactorial, that is, it most often occurs when several kinds of injury to muscle occur at the same time.

Moreover, this kind of muscle tissue dissolution has different causes at different stages of life.

  • In children, rhabdoymyolysis most commonly occurs after infection.
  • In adults, rhabdomyolysis most commonly occurs after crushing injury.
  • At any age, rhabdomyolysis can be a complication of a medical procedure gone wrong.

Broken bones can cause pressure on muscles that leads to muscle tissue breakdown. There are high rates of rhabdomyolysis after earthquakes. There are also high rates of the condition in traffic accidents.

Damage to blood vessels that supply the muscles after surgical clamping or trauma can trigger muscle breakdown.

Certain medications, notably the statins (Crestor, Lipitor, Mevacor, Zocor, and others) can deprive muscle tissue of the enzymes it needs to make energy, so that muscle tissue breaks down, sometimes just a few weeks after starting the drug.

And rhabdomyolysis can result from:

  • Fever.
  • Heart stroke.
  • Cocaine abuse.
  • Overdoses of "molly" or PCP.
  • Near-drowing.
  • Stroke.
  • Extensive burns.
  • Status epilepticus, that is, prolonged seizures.
  • Immobilization or forced bed rest, especially after traumatic injury.
  • Infections with Streptococcus, Staphylococcus, E. coli, fungi, yeast, and many other kinds of microorganisms.

What Is the Disease Process in Rhabdomyolysis?

Even though the dissolution of muscle tissue can be initiated by many different kinds of injuries and infections, the common denominator in rhabdomyolysis is damage to a part of the muscle known as the sarcolemma. The cell loses its ability to regulate the flow of electrically charged particles in and out, so its surface becomes less and less able to "grab" passing oxygen, amino acids, and glucose. Eventually the cell fills up with sodium (the positively charged ion from salt) and water and literally dissolves.

When this happens, the contents of the cell combine with hemoglobin in the bloodstream. Blood vessels tighten. The amount of fluid reaching the kidneys decreases. Free radicals form and attack the kidneys, which may cease to function.

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