Rhabdomyolysis in marathon runners refers to a condition where damaged skeletal muscle cells release their contents, including myoglobin, into the bloodstream. In some cases, rhabdomyolysis leads to acute kidney injury (AKI).
There will be many cases in the London Marathon today – especially as its a warm day – with renal teams at London hospitals on full alert.
Causes
- Running-induced rhabdomyolysis is often caused by overexertion, dehydration, heat stress, or pre-existing medical conditions, which can lead to muscle damage and breakdown.
Symptoms
- Common symptoms include muscle pain or weakness, dark or tea-colored urine, fatigue, nausea, and confusion.
- Recognising these symptoms early is crucial for prompt treatment.
- Hospital admission is almost always required.
Diagnosis
- Diagnosis is based on history, and U&E and creatine kinase (CK) levels. These may reveal pre-renal AKI.
- Examination may reveal dehydration and muscles may be tender.
- Urine tests may detect myoglobin and other muscle breakdown products.
Typical natural history of rhabdomyolysis, if AKI occurs. CK rise is early, as can be seen.
Treatment
- Treatment involves IV fluid replacement, pain management, and daily monitoring of kidney function. Most cases are self-limiting.
- A few will require short-term dialysis – usually on day 3-4 after admission (due to pattern of bloods above).
- Kidney function usually returns to baseline. And long-term renal damage (i.e. CKD, or ESRF) is, fortunately, very rare.
Prevention
- To reduce risk, marathon runners – at London, or wherever – whilst training, should gradually increase running intensity and duration.
- On the day, they should stay hydrated, monitor their body’s warning signs, avoid running in extreme conditions, and listen to their body.
- They should stop if they feel unwell, especially with the symptoms above.
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