Why the New Rating System May Prevent Kidney Failure Deaths

Traditionally, doctors have been on the lookout for kidney failure when they see the three classic symptoms of muscle tissue breakdown:

• Muscle pain.

• Fatigue.

• Dark urine.

When these three symptoms show up in someone who has been in an accident, or who has a broken bone, or who has been through a serious infection, a heart attack, a stroke, heat stroke, dehydration, or drug overdose, then doctors monitor kidney function to make sure the patient gets put on dialysis just as soon as it is needed.

The problem with relying on this triad of symptoms for beginning kidney care is that rhabdomyolysis doesn't always present itself with easily recognized diagnostic signs. Only about 50% of adults who go on to need renal dialysis show all three symptoms, and even fewer children who later need dialysis show all three. 

Extreme exercise, such as running a marathon, may present these three symptoms, but athletes may ignore them as normal. Someone whose muscles being to break down after an overdose of ecstasy, cocaine, or PCP isn't likely to appear fatigued. And when the underlying cause occurs during surgery, grogginess after anesthesia and painkillers and the nurse's inattention to urine output may delay recognition of the need for treatment.

Dr. Karandeep Singh (MD)'s new online calculation tool takes the guesswork out of predicting the need for dialysis.

Users of the tool simply click boxes for age, gender, and whether or not there is:

• Myositis (known muscle inflammation),
• Statin use,
• Seizure, or 
• Excessive exercise.

Then the user of the online risk assessment tool clicks boxes for several very common, objective laboratory measurements including:

• Creatinine,
• Calcium,
• CO2,
• CPK, and
• Phosphate.

The user clicks on the "calculate" button and the algorithm computes the probability of kidney failure.

It is not a substitute for medical diagnosis. If you get a low probability of kidney failure (and having played with the numbers, I can tell you it's impossible to make the algorithm predict a 0% risk of kidney failure), you still need your doctor's attention. You just probably don't have an urgent need to arrange for possible dialysis.

If you need dialysis and you don't get it, you will die.

Rhabdomyolysis is generally treatable when it is diagnosed in time. If you are concerned about whether your muscle injury or statin use might be causing you kidney injury, get a copy of your lab results and use the online calculator, linked below.

But don't use the calculator as a substitute for medical care. Use it to make sure you get all the medical care you need.