Myoglobinuria is the presence of myoglobin in urine, often caused by muscle destruction. It can occur in trauma patients, athletes, and those with metabolic disorders. Symptoms include muscle pain and weakness, and complications can include acute kidney injury. Treatment involves rehydration and medication.
Myoglobinuria describes a condition in which a protein known as myoglobin is present in the urine. Myoglobin carries oxygen to skeletal and cardiac muscles to maintain their normal functions. When rhabdomyolysis or muscle destruction occurs, myoglobin is usually released into the bloodstream. It is then filtered by the kidneys and excreted in the urine. Myoglobinuria usually occurs in trauma patients who have crush injuries and in individuals who perform strenuous exercise.
Athletes are at risk for muscle damage due to a combination of factors such as dehydration, poor training and heat exhaustion. In children, viral infections such as influenza can lead to rhabdomyolysis and myoglobinuria. Other conditions associated with myoglobinuria include potassium deficiency, metabolic disorders such as phosphofructokinase deficiency, and inherited muscle diseases such as McArdle disease. Certain dietary supplements, drug abuse, and prescription drugs may also be implicated in myoglobinuria.
Typical symptoms experienced by patients with rhabdomyolysis are muscle pain and muscle weakness which often results in difficulty moving. The laboratory test to detect myoglobinuria, called urine myoglobin, involves examining a patient’s urine sample. The color of urine may become darker due to the presence of myoglobin. Once trauma patients and those with possible muscle injuries are evaluated for myoglobinuria, they are usually treated promptly to prevent complications from developing.
A serious complication of myoglobinuria is acute kidney injury, in which a patient experiences a sudden decrease or loss of kidney function. This usually occurs when myoglobin forms deposits in kidney cells and causes blockage or toxic damage to the area. Patients with acute kidney injury usually experience confusion, decreased urination, swelling in different parts of the body, and bleeding. Other complications are hyperkalemia, which is increased potassium in the blood, and hypocalcemia, which is decreased calcium levels in the blood.
A blood test called a creatine kinase (CK) test can also be used to evaluate patients for muscle damage. Creatine kinase is a protein also found in the brain, heart, and skeletal muscles, and its levels usually rise when muscle injury occurs. Patients who have myoglobin in their urine or elevated CK levels in their blood are often eligible for treatment. Intravenous (IV) fluid is often given to rehydrate patients, and sodium bicarbonate may be added to make the urine alkaline. Other medications to improve urination may also be given.
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