Rhabdomyolysis and Renal Problems

Exertional rhabdomyolysis is the breakdown of skeletal muscle after intense or unaccustomed exercise, releasing creatine kinase (CK) and myoglobin into the blood, and its main danger is acute kidney injury (AKI).

It causes significant muscle pain, often with swelling or weakness. Dark urine is a classic sign but occurs in only a minority. Diagnosis rests on muscle symptoms after exercise together with a raised CK, not on a CK level alone, and fluids are the basis of treatment.

For the sport and exercise medicine (SEM) clinician, the priorities are recognising it, deciding who can be managed as an outpatient, spotting the features that point to an underlying cause, and interpreting the other urinary changes exercise produces, such as exercise haematuria.