I think there are two clinical questions:
1 Is rhabdomyolysis occurring?
2 How much kidney damage is there?
The issue has been clouded by the concept that the myoglobin in the
plasma when rhabdomyolysis occurs is directly and predominantly
responsible for the renal damage. Add in a bit of reasoning by
biological plausibility and we should expect people to be attached to
trying to detect myoglobin in urine. However the nephrotoxicity in
rhabdomyolysis is not solely caused by myoglobin: acidosis, low
perfusion pressure and probably other factors are all involved.
I think the answers to the questions are therefore:
1 No laboratory investigation is better than measuring plasma CK
2 Follow as in other causes of acute renal damage, including measuring
urine output and serial plasma creatinine concentration.
Dr Jonathan Kay
On Tuesday, April 9, 2002, at 03:53 , TICKNER TREVOR (RM1) Norfolk and
Norwich NHS Trust wrote:
> There are several questions here.
>
> 1) Does raised CK tell you that there is myoglobinuria?
> 2) Can myoglobinuria exist without raised CK?
> 3) Does treatment of myoglobinuria benefit the patient?
>
> The answer to 1) is no - or at least not in all situations. See, for
> example
> http://www.aaos.org/wordhtml/anmeet92/scipro/ppr313.htm
> I do not know the answer to 2) and would be interested in the evidence.
> I believe that the evidence for benefit to the patient of active
> treatment
> is limited but generally medical wisdom is that diuresis is warranted.
>
> Trevor Tickner,
> Norwich
>
>> -----Original Message-----
>> From: Gerald. Maguire [SMTP:[log in to unmask]]
>> Sent: 09 April 2002 15:33
>> To: [log in to unmask]
>> Subject: Re: Heavy myoglobinuria and urine colour
>>
>> What does the measurement of urine myoglobin tell you that the
>> measurement
>> of serum CK does not?
>> After consultation with the critical care teams (ITU and neuro), we
>> stopped
>> measuring urine myoglobin about 18 months ago and nobody misses it.
>>
>> Gerald A Maguire
>> Dept of Clinical Biochemistry and Clinical Immunology
>> Addenbrooke's Hospital
>> Cambridge
>> CB2 2QR
>> UK
>> Tel 44 (0) 1223 217159
>> fax 44 (0) 1223 217794
>>
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