Pathophysiology of acute renal failure in rhabdomyolysis; A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today.
He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. The patient also reports a history of exercise-induced asthma and uses albuterol sulfate HFA as needed.
On physical exam, the patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL. Strength lower extremities 5 and DTRs 2. Left calf erythematous, edematous, warm, and tender on palpation. Pulses 3
- Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis.
- ordered Stat ultrasound of left leg to rule out DVT and read as normal
- CBC WNL
- Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L)
- BUN and Creatinine WNL
- A diagnosis of rhabdomyolysis was made.Discuss the pathophysiology of acute renal failure in rhabdomyolysis.