Strenuous Exercise-induced Double Trouble: Rhabdomyolysis Meets Acute Interstitial Nephritis

Exercise-induced rhabdomyolysis and resultant acute kidney injury (AKI) are becoming an important cause of concern. A young male in his 30s reported to the emergency with severe myalgias and red-brownish urine 3 days following strenuous gym training. Laboratory results indicated high creatine phosphokinase and lactate dehydrogenase levels, myoglobinemia, and AKI. While the rhabdomyolysis improved, the azotemia worsened, requiring additional sessions of hemodialysis. Detailed workup for various etiologies of rapidly progressive renal failure, followed by a kidney biopsy, revealed acute interstitial nephritis coexisting with pigment cast nephropathy. He responded well to a short course of steroids and achieved reversibility of his baseline renal functions over the next 2 months.