What is the primary renal complication associated with crush injury–related rhabdomyolysis?

• A. Acute kidney injury
• B. Liver failure
• C. Cardiac failure
• D. Stroke

Answer: (A)

Crush injury–related rhabdomyolysis primarily causes acute kidney injury through pigment nephropathy from released myoglobin. When damaged muscle breaks down, myoglobin enters the bloodstream and is filtered by the kidneys. In the tubules, myoglobin is toxic to tubular cells and can form obstructive casts, especially with dehydration or acidic urine, leading to tubular injury and reduced filtration. This sequence produces acute kidney injury that can progress to renal failure if not managed with prompt fluid resuscitation and measures to minimize myoglobin precipitation. Other organ failures such as liver failure, cardiac failure, or stroke aren’t the main renal complication in this scenario; they may occur but the kidney-specific issue is acute kidney injury from myoglobin-induced tubular damage.