Myoglobinuria
 | This article needs more primary sources. (September 2015) |  |
| Myoglobinuria | |
|---|---|
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| Urine from a person with rhabdomyolysis showing the characteristic brown discoloration as a result of myoglobinuria | |
| Specialty | Nephrology |
Myoglobinuria is the presence of myoglobin in the urine, which usually results from rhabdomyolysis or muscle injury.[1] Myoglobin is present in muscle cells as a reserve of oxygen.
Signs and symptoms
Signs and symptoms of myoglobinuria are usually nonspecific and needs some clinical prudence. Therefore, among the possible signs and symptoms to look for would be:[2]
- Swollen and painful muscles
- Fever, nausea
- Delirium (elderly individuals)
- Myalgia
- Dark urine
- Calcium ion loss
Causes
Other causes of myoglobinuria include:
- McArdle's disease
- Phosphofructokinase deficiency[3]
- Carnitine palmitoyltransferase II deficiency
- Malignant hyperthermia
- Polymyositis
- Lactate dehydrogenase deficiency
- Adenosine monophosphate deaminase deficiency type 1
- Thermal or electrical burn
- Muscular dystrophy
Pathophysiology
Myoglobinuria pathophysiology consists of a series of metabolic actions in which damage to
Diagnosis
After centrifuging, the urine of myoglobinuria is red, where the urine of hemoglobinuria after centrifuge is pink to clear.
Treatment
Hospitalization and IV hydration should be the first step in any patient suspected of having myoglobinuria or rhabdomyolysis. The goal is to induce a brisk diuresis to prevent myoglobin precipitation and deposition, which can cause acute kidney injury. Mannitol can be added to assist with diuresis. Adding sodium bicarbonate to the IV fluids will cause alkalinization of the urine, believed to reduce the breakdown of myoglobin into its nephrotoxic metabolites, thus preventing renal damage. Often, IV normal saline is all that is needed to induce diuresis and alkalinize the urine.
Epidemiology
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See also
- Pigmenturia
References
- ^ Prasad Devarajan, MD, FAAP (2020-02-19). "Myoglobinuria: Background, Pathophysiology, Etiology". Medscape Reference. Retrieved 2020-07-13.
Myoglobinuria is usually the result of rhabdomyolysis or muscle destruction. When excreted into the urine, myoglobin, a monomer containing a heme molecule similar to hemoglobin, can precipitate, causing tubular obstruction and acute kidney injury.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ "Rhabdomyolysis and Other Causes of Myoglobinuria". Patient. EMIS Group. Retrieved 10 September 2015.
- PMID 18421897.
- ^ "Myoglobinuria". eMedicine. Medscare. Retrieved 10 September 2015.
- PMID 17338959.
Further reading
- Rowland, L.P.; Pedley, T.A.; Merritt, H.H. (2010). Merritt's Neurology. Lippincott Williams & Wilkins. ISBN 978-0-7817-9186-1. Retrieved October 22, 2023.
- Hoffmann, G.F.; Zschocke, J.; Nyhan, W.L. (2009). Inherited Metabolic Diseases: A Clinical Approach. Springer Berlin Heidelberg. ISBN 978-3-540-74723-9. Retrieved October 22, 2023.
External links
- Overview on the Neuromuscular disease center website.
