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2017 ; 3
(1
): e000241
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Risk factors for exertional rhabdomyolysis with renal stress
#MMPMID29147573
Apeland T
; Danielsen T
; Staal EM
; Åsberg A
; Thorsen IS
; Dalsrud TO
; Ørn S
BMJ Open Sport Exerc Med
2017[]; 3
(1
): e000241
PMID29147573
show ga
BACKGROUND: Exercise-induced rhabdomyolysis denotes the exertional damage of
myocytes with leakage of sarcoplasmic content into the circulation. The purpose
of this study was to determine important risk factors for the development of
exertional rhabdomyolysis in a temperate climate and to study the renal effects
of myoglobinuria. METHODS: A cluster of eight military recruits was admitted to
hospital due to exertional rhabdomyolysis with myoglobinuria. The patients were
treated according to current guidelines with isotonic saline and alkalinisation
of the urine. The eight patients were compared with a randomly selected control
group of 26 healthy fellow recruits. All subjects responded to a standardised
questionnaire. RESULTS: There were little differences in baseline characteristics
between patients and controls. In the present study, exercise intensity, duration
and type were all significant determinants of exertional rhabdomyolysis in
univariate models. However, in a multivariate model, high exercise intensity on
day -1 was the only significant predictor of rhabdomyolysis (p=0.02). All
patients had a stable serum creatinine and cystatin C. There was a significant
increase in serum neutrophil gelatinase-associated lipocalin (NGAL) in the
patients, suggesting renal stress. CONCLUSIONS: Sustained maximal intensity
exercise is a crucial risk factor for rhabdomyolysis with gross pigmenturia.
Elevated serum NGAL concentrations indicate the presence of renal stress. It
appears to be possible to quantify the risk of rhabdomyolysis by means of a
simple questionnaire. In the future, this may be used as a tool to prevent
rhabdomyolysis.