The syndrome of rhabdomyolysis: Complications and treatment

Renal ischemia, formation of myoglobin casts at the distal convoluted tubules, and the cytotoxic effect of iron (Fe) on the epithelial cells of the proximal convoluted tubules are the principal pathogenetic mechanisms of myoglobinuric acute renal failure (ARF). Coexisting hypovolemia and acidic urine pH further intensify these processes. Acute renal failure is induced by the combination of a decreased oxygen supply at the tubular cells, tubular obstruction, and acute tubular necrosis (ATN). NO, nitric oxide.