Ischemia-Induced Muscle Myonecrosis, Myoglobinuria, and Secondary Kidney Failure

Despite many advances in the management of acute limb ischemia, this sudden-onset disease entity continues to have a high morbidity and mortality related both to limb loss and to the development of adverse systemic complications that can lead to renal failure, arrthymia, acute respiratory distress syndrome (shock lung), and death. Improvements in catheter-based delivery of lytic agents have contributed to improved outcomes, but the overall 1-month limb-loss rate remains significant, ranging from 5% to 16%. More alarming are the 1-month mortality rates, ranging from 5% to 12%. This excessive mortality stems from the patient’s underlying chronic comorbidities as well as the systemic complications related to ischemia and reperfusion, namely, ischemia-induced muscle myonecrosis, myoglobinuria, and secondary kidney failure.

Haimovici was the first to recognize the adverse cascade of events that developed with reperfusion of an ischemic extremity and coined the term the myonephropathic-metabolic syndrome . Despite the restoration of arterial flow into a previously ischemic extremity, and paradoxically because of it, patients develop the secondary complications of acidosis, hyperkalemia, rhabdomyolysis, myoglobinuria, and kidney failure, potentially culminating in amputation or death.