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Last reviewed: 28 Oct 2023
Last updated: 02 Nov 2022



History and exam

Key diagnostic factors

  • recent crush injury
  • prolonged immobilization
  • presence of other risk factors
  • muscular pain or weakness
More key diagnostic factors

Other diagnostic factors

  • general malaise
  • dark urine
  • muscular swelling
  • muscular tenderness
  • diminished peripheral pulse
  • prolonged capillary refill
Other diagnostic factors

Risk factors

  • trauma
  • alcohol
  • cocaine
  • amphetamine
  • phencyclidine
  • narcotics
  • diuretics
  • statins
  • salicylate toxicity
  • toxins
  • envenomation
  • inflammatory disorders
  • muscle hypoxia
  • genetic disorders
  • metabolic disorders
  • infection
  • increased body temperature
  • antipsychotics
More risk factors

Diagnostic investigations

1st investigations to order

  • serum creatine kinase (CK) level
  • serum electrolytes
  • renal function
  • liver function
  • CBC
  • coagulation studies
  • urine dipstick
  • urine microscopy
  • myoglobin levels
More 1st investigations to order

Investigations to consider

  • muscle biopsy
  • thyroid-stimulating hormone
  • erythrocyte sedimentation rate
  • antinuclear antibodies
  • toxicology screen
More investigations to consider

Treatment algorithm


crush injury and/or creatine kinase >5 times normal or >1000 IU/L

acute kidney injury refractory to initial therapy



Chinmay Patel, MD, FASN

Nephrology Specialist

East Texas Kidney Specialists




CP is an author of one reference cited in this topic.

Aditya Kadiyala, MD, MPH

Vice Chair

Department of Medicine

Division of Nephrology

University of Maryland

Charles Regional Medical Center

La Plata



AK declares that he has no competing interests.


Dr Chinmay Patel and Dr Aditya Kadiyala would like to gratefully acknowledge Dr Mark Shapiro, Dr Courtney Sommer, and Dr Robert D. Mathis, previous contributors to this topic.


MS is an author of references cited in this topic. CS and RDM declare that they have no competing interests.

Peer reviewers

Timothy Albertson, MD, PhD, MPH


Division of Pulmonary and Critical Care Medicine

University of California, Davis




TA declares that he has no competing interests.

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