# Rhabdomyolysis: Muscle Injury Becomes Kidney Risk

Early electrolyte release and later recovery losses require monitoring. Treat the precipitant and plan recovery of kidney and muscle function.

![Infographic: Rhabdomyolysis: Muscle Injury Becomes Kidney Risk](https://urinenephrology.org/visual-reference/images/mastery-rhabdomyolysis.png?v=20261003c)

## Cell contents escape

Muscle breakdown releases myoglobin, potassium, phosphate, and enzymes. Kidney injury reflects pigment toxicity, tubular obstruction, and associated perfusion disturbances.

## Recognize varied triggers

Trauma, prolonged immobilization, exertion, seizures, drugs, infections, and metabolic disorders can cause rhabdomyolysis. The classic symptom triad is not required.

## Assess threats early

Check potassium, ECG, kidney function, acid–base status, creatine kinase trends, and volume status. Assess for compartment syndrome and the underlying cause.

## Let perfusion and congestion guide fluid

Use isotonic crystalloid when resuscitation is needed, and reassess blood pressure, urine output, lungs, and congestion. Persistent anuria or new pulmonary edema is a reason to reassess and escalate, not keep increasing fluid to chase a urine-output goal.

## Do not treat CK as a dialysis trigger

Refractory hyperkalemia, severe acidosis, pulmonary edema, or other usual AKI indications determine KRT need. Routine bicarbonate or mannitol is not recommended to prevent rhabdomyolysis-associated AKI. Avoid routine treatment of asymptomatic early hypocalcemia; symptomatic or cardiac indications still require action.

## Follow the changing phase

Early electrolyte release and later recovery losses require monitoring. Treat the precipitant and plan recovery of kidney and muscle function.

## Supporting evidence

- [AAST rhabdomyolysis clinical consensus](https://pmc.ncbi.nlm.nih.gov/articles/PMC8804685/)

## Source lessons

- [rhabdomyolysis](https://urinenephrology.org/mastery/aki-advanced/rhabdomyolysis.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.