Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury.

Abstract

Serum creatine kinase (CK) is routinely used as a marker in the assessment of rhabdomyolysis and acute myoglobinuric kidney injury (Mb-AKI), while the use of myoglobin is much less explored in this respect. We retrospectively analyzed the incidence of Mb-AKI (creatinine [Cr] > 200 μmol/L) and the need for hemodialysis (HD) in 484 patients (70.5% males) with suspected rhabdomyolysis, grouped according to peak serum myoglobin (A: 1-5 mg/L, B: 5-15 mg/L, C: >15 mg/L). The median peak myoglobin was 7163 μg/L. Both peak Cr and peak CK were significantly higher in group C. The incidence of Mb-AKI was 24.6% in group A, 38.6% in group B (P < 0.01 vs. group A), and significantly higher (64.9%) in group C (P < 0.001 vs. groups A and B). Fifty-one patients (10.5%) needed HD, the proportion increasing from 6.7% in group A, and 12.3% in group B (NS), to 28.1% in group C (P < 0.001 vs. group A, P 0.01 vs. group B), and reaching 36.8% with myoglobin >20 mg/L. Creatine kinase correlated with the severity of rhabdomyolysis, but less so with Mb-AKI. The peak Cr levels were not significantly different between patients divided by CK 60 μkat/L, or grouped into CK tertiles or quartiles. A significant proportion of patients with rhabdomyolysis experienced Mb-AKI, whose frequency increased in parallel with myoglobin levels. Myoglobin levels above 15 mg/L were most significantly related to the development of AKI and the need for HD. Blood myoglobin could serve as a valuable early predictor and marker of rhabdomyolysis and Mb-AKI.

• Authors: Vladimir Premru, Janko Kovač, Rafael Ponikvar
• Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy (Ther Apher Dial) Vol. 17 Issue 4 Pg. 391-5 (Aug 2013) ISSN: 1744-9987 [Electronic] Australia
• PMID: 23931877 (Publication Type: Journal Article)
• Copyright: © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

Chemical References

• Biomarkers
• Myoglobin
• Creatine Kinase

Topics

• Acute Kidney Injury (diagnosis, etiology, physiopathology)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Child
• Creatine Kinase (blood)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Myoglobin (blood)
• Myoglobinuria (etiology)
• Renal Dialysis
• Retrospective Studies
• Rhabdomyolysis (complications, diagnosis, physiopathology)
• Severity of Illness Index
• Young Adult