Myoglobinuria

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Myoglobinuria
Model of helical domains in myoglobin.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D. Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Myoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. Myoglobin is present in muscle cells as a reserve of oxygen.

Pathophysiology

Under ideal situations myoglobin will be filtered and excreted with the urine, but if too much myoglobin is released into the circulation or in case of renal problems, it can occlude the renal filtration system leading to acute tubular necrosis and acute renal insufficiency.

Causes

Common Causes

• Burns
• Crush syndrome
• Electrolyte imbalance such as Hypokalaemia and Hyperphosphatemia
• Exercise
• Heat stroke
• Medication such as Statins and Fibrates
• Rhabdomyolysis
• Seizures
• Trauma

Causes by Organ System

Cardiovascular	Myocardial infarction, Myocarditis
Chemical/Poisoning	Haff disease, Snake bite , Venom
Dental	No underlying causes
Dermatologic	Dermatomyositis
Drug Side Effect	Barbiturates, Carbenoxolone, Diamorphine, Fibrate, Malignant hyperpyrexia, Neuroleptic malignant syndrome, Statins, Trabectedin
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Heat stroke
Gastroenterologic	No underlying causes
Genetic	Brody myopathy, Carnitine palmitoyltransferase 1 deficiency, Carnitine palmitoyltransferase 2 deficiency, Familial paroxysmal rhabdomyolysis, Glycogen storage disease type V, Myopathy with deficiency of succinate dehydrogenase and aconitase, Phosphoglycerate kinase deficiency, Phosphogylcerate mutase 2 deficiency, Very long-chain acyl-coenzyme A dehydrogenase deficiency
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	Brody myopathy, Compartment syndrome, Dermatomyositis, Polymyositis, Rhabdomyolysis
Neurologic	Choreoathetosis, Seizures
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes]
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Hypokalaemia, Hypophosphataemia
Rheumatology/Immunology/Allergy	Dermatomyositis, Polymyositis
Sexual	No underlying causes
Trauma	Burns, Crush syndrome, Electric shock, Trauma
Urologic	No underlying causes
Miscellaneous	Exercise, Meyer-betz disease

Causes in Alphabetical Order

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3

Differentiating Myoglobinuria from Hemoglobinuria

After centrifuge, the serum of myologinuria is clear, where the serum of hemoglobinuria after centrifuge is pink.

Centrifuse Result

Sediment Red

Supernatant Red

Hematuria

Dipstick heme

Negative

Positive

❑ Beeturia ❑ Phenazopyridine ❑ Porphyria ❑ Other

❑ Myoglobin ❑ Hemoglobin

Plasma color

Clear

Red

Myoglobinuria

Hemoglobinuria