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Rabdomiolisis es la destrucción de las fibras musculares y se caracteriza clínicamente por dolor, edema y debilidad muscular, orina color rojo-café (mioglobinuria) y la elevación por un corto período de la enzima creatinquinasa en sangre. Entre las múltiples causas de rabdomiolisis está el ejercicio intenso. La rabdomiolisis inducida por el ejercicio está escasamente documentada en la población pediátrica y en general requiere descartar alguna patología metabólica de base. Las complicaciones de la rabdomiolisis pueden ser múltiples y graves: falla renal, arritmias cardíacas, síndrome compartamental, coagulación intravascular diseminada, acidosis láctica, etc. La falla renal es consecuencia de la necrosis tubular aguda secundaria al taponamiento de los túbulos renales por la mioglobina, que puede llegar a ser fatal. Comunicamos nuestra experiencia con tres adolescentes que después de iniciar un programa de entrenamiento físico, desarrollaron intenso dolor y edema muscular constatándose un significativo aumento de la enzima creatinquinasa y edema muscular en la ultrasonografía de los músculos utilizados en el ejercicio. El estudio complementario descartó una patología metabólica de base en todos ellos. El tratamiento oportuno incluyó terapia sintomática e hidratación intravenosa. No se desarrolló insuficiencia renal en ninguno. Frente al incremento no controlado del entrenamiento físico, el diagnóstico oportuno de esta patología permite evitar sus graves consecuencias.

Rhabdomyolysis implies injury to the muscle fibers. The hallmark clinical manifestations are pain, oedema, muscle weakness and dark urine (myoglobinuria). There is an increase, for a short time, of the muscle enzyme creatine kinase in blood. Exercise induced rhabdomyolysis is one of various causes of rhabdomyolysis but has been rarely documented in the pediatric population. In general it is always important to exclude an underlying metabolic pathology. Complications of rhabdomyolysis can be many and severe: renal failure, cardiac arrhythmias, compartment syndrome, disseminated intravascular coagulation, lactic acidosis, etc.. Renal failure is the consequence of the acute tubular necrosis secondary to the obstruction of the renal tubules by myoglobin, which can become fatal. We report our experience with three adolescents that after starting a program of physical training, developed intense pain and muscle oedema at the ultrasound scan of the muscles involved in the exercise. Complementary studies excluded an underlying metabolic disease in all of them. The opportune treatment included symptomatic treatment and endovenous hydratation. Fortunately, none of them developed renal failure.

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BACKGROUND: Myoglobinuric acute renal failure causes increased oxidative stress. Since ethanol upregulates renal antioxidant enzymes and wine polyphenols behave as antioxidants, we tested the hypothesis that red wine components would ameliorate the renal damage caused by rhabdomyolysis. METHODS: Adult rats received water (control), alcohol-free red wine, ethanol 12.5% (v/v) or red wine for 10 weeks. Rhabdomyolysis was induced by glycerol injection (50%, 10 ml/kg, i.m.), and urine and blood samples were collected 6 h later to measure renal function parameters, creatine kinase (CK) activity, free F(2)-isoprostanes and total antioxidant capacity. Kidneys were then harvested for morphological studies and determinations of lipid peroxidation, protein carbonylation, (Na + K)-ATPase and antioxidant enzyme activities. RESULTS: In the control group, myoglobinuria was associated with a 68% decrease in creatinine clearance and increases in plasma creatinine and blood urea nitrogen of 3.2 and 1.8 times above baseline, respectively. Controls also showed increases in plasma free F(2)-isoprostanes levels and CK activity, together with enhanced renal expression of the antioxidant enzymes catalase, glutathione peroxidase and superoxide dismutase, as well as increased production of malondialdehyde and carbonyls. Rhabdomolysis reduced renal (Na + K)-ATPase activity and this reduction was associated with a 5-fold increase in fractional sodium excretion as well as morphological damage to the kidney. These changes were significantly attenuated by pretreatment with chronic red wine exposure prior to glycerol injection. A less marked degree of functional and biochemical protection was also observed in response to the administration of alcohol-free red wine and ethanol. CONCLUSIONS: The present data suggest that red wine protects against functional, biochemical and morphological damage caused by rhabdomyolysis in the rat, and this protection may be due to the synergistic effects of ethanol and non-alcoholic red wine components.

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Rhabdomyolisis most commonly occurs after muscle injury, alcohol ingestion, drug intake and exhaustive exercise. Prolonged muscle compression at the time of surgery may produce this complication. Obesity has been reported as a risk factor for pressure-induced rhabdomyolysis, but no reports associated with bariatric surgery could be found in the literature. We report 3 superobese patients who developed rhabdomyolysis after bariatric surgery. This complication was attributed to direct and prolonged pressure of the bed against the dorsal and gluteal muscles.

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A young, active duty sailor presented with right upper quadrant abdominal pain. History, physical, and laboratory findings initially suggested cholecystitis or related disease. Further evaluation found myoglobinuria and a recently increased exercise program, leading to the diagnosis of exercise-induced right upper abdominal wall rhabdomyolysis. Although not a common cause of abdominal pain, this diagnosis should be considered in the patient with abdominal pain and a recently increased exercise program, particularly exercises of the abdominal wall such as "abdominal crunches."

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Reportamos el caso de un paciente masculino de 22 años de edad de raza negra, el cual al bañarse en la playa tuvo un episodio de inmersión de 3 a 5 minutos con casi ahogamiento y realización de grandes esfuerzos para lograr salir a la superficie del agua y sobrevivir. Dos horas después del accidente se quejó de sed y dolor en los muslos siendo internado en un centro privado de salud y manejado con furosemida y fluidos endovenosos. Su orina 4 horas despues del accidente era de color marrón oscura. Sus enzimas SGOT y CPK resultaron elevadas en el plasma y en la orina se reportó 3+ de sangre con 90 a 95 eritrocidos pc. Su cuadro clínico mejoró gradualmente y fue dado de alta al 5to día de su internamiento. Visto 25 días despues, llevaba una vida completamente normal

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Myophosphorylase deficiency (McArdle disease) is characterized by exercise intolerance that usually starts in childhood. Severe cramps and myoglobinuria are rarely problems in children. We describe an 8-year-old boy with exercise-induced myoglobinuria; he was homozygous for the mutation most commonly encountered in patients with typical McArdle disease.

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El presente trabajo resume las características principales de la rabdomiolisis y la mioglobinuria. Se analizan los factores etiológicos y fisiopatológicos implicados en la producción de la rabdomiolisis, sus manifestaciones clínicas más frecuentes con un enfoque terapéutico racional basado en estas consideraciones y en los métodos diagnósticos disponibles

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La rabdomiolisis idiopática aguda es una de las miopatías poco frecuentes con sintomatología definida; se presenta predominantemente en personas jovenes sometidas a ejercicios extenuantes; su manifestación mas sobresaliente es la presencia de pigmenturia la cual puede conducir a insuficiencia renal aguda, con gran morbimortalidad si no se trata oportunamente. Se presenta el caso de un soldado en quien se asocian Diabetes Mellitus Tipo I y compromiso muscular y a quien se practicaron estudios bioquímicos, electromiográficos y biopsia muscular. Se discuten los diferentes aspectos de la enfermedad y se llama la atención sobre las características clínicas y paraclínicas, para llegar a un diagnóstico completo

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The venom of the Brazilian rattlesnake Crotalus durissus terrificus is know to have hemolytic and neurotoxic physiopathological activities which may cause acute renal failure with hemoglobinuria and/or methemoglobinuria. As far as we know, no report has been published on the ability of the venom of this rattlesnake species to cause rhabdomyolysis. In the present paper we demonstrate that the venom of Brazilian snakes of the genus Crotalus can induce systemic myonecrosis. Clinical, laboratory and anatomo-pathological data for two patients referred to the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, 24 hr after a rattlesnake bite, are presented. In both cases, exaggerated elevation of serum levels of the enzymes creatine phosphokinase, lactate dehydrogenase and glutamic-oxaloacetic transaminase were detected, as well as data suggesting acute hypercatabolic renal failure. Immunoelectrophoresis of the serum and urine of these patients, carried out against specific anti-myoglobin serum (Behringwerke), demonstrated myoglobinemia and myoglobinuria, confirming injury to muscle tissue. Electron microscopy of a calf muscle biopsy taken from the leg contralateral to the bite from one patient revealed foci of myonecrosis.

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This disease was described by McArdle as an inherited autosomal recessive affection characterized by glycogen storage with normal chain in the skeletal muscles, due to absence of myophosphorylase activity. Under a clinical aspect, excessive fatigability, cramps and myoglobinuria appear following physical exercise. A case of this disease in a 36-year-old male patient is reported. Failure of elevation of venous blood lactate after physical effort under anaerobic conditions, as well as muscle histochemistry, made diagnosis confirmation possible. The authors comment on the differential diagnosis between McArdle's disease and the other causes of myoglobinuria, specially phosphofructokinase and carnitine-palmityl-transferase deficiency.

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