Rhabdomyolyse du patient en Réanimation : étiologies, physiopathologie et prise en charge

Abstract

Rhabdomyolysis is a common condition in intensive care, characterized by skeletal muscle breakdown and release of myoglobin, which may cause acute kidney injury (AKI). AKI occurs in over half of severe cases and is the main driver of morbidity and mortality. Management relies on early and aggressive fluid resuscitation to prevent renal injury, reduce myoglobin precipitation, and correct metabolic disturbances. Renal replacement therapy (RRT) is considered based on clinical course. Several innovative therapies are under investigation, including hemoadsorption, anti-myoglobin antibodies, and inhibition of local inflammatory responses. These approaches aim to modulate early pathophysiological mechanisms but require validation in human studies. Progression to chronic kidney disease is increasingly recognized, with a significant proportion of patients showing persistent renal impairment at 3 months, underscoring the need for post-ICU nephrological follow-up. This review provides an updated overview of the causes, pathophysiology, diagnosis, and management of rhabdomyolysis in critically ill patients, with a particular focus on kidney injury and emerging therapeutic strategies.