Myoglobinuria diagnostic study of choice: Difference between revisions

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The most important laboratory test is [[creatine kinase]] (CK) levels to assess for [[rhabdomyolysis]].
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Myoglobin is the first enzyme to increase, but it returns to normal levels within 24 hours after the onset of symptoms. The reason is that myoglobin is rapidly cleared  by the kidneys from the serum into the urine. Serum CK levels may remain elevated after serum and urine test results for myoglobin have become negative. CK levels typically peak {1000 U/L) about 3 days after the onset of symptoms, and remain elevated for several days. <ref name="pmid25365815">{{cite journal| author=Lee G| title=Exercise-induced rhabdomyolysis. | journal=R I Med J (2013) | year= 2014 | volume= 97 | issue= 11 | pages= 22-4 | pmid=25365815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25365815  }} </ref>
{{CMG}} {{AE}} {{AKS}}


Acute renal insufficiency (elevated BUN and creatinine levels) is a sequel of severe [[myoglobinuria]] in which the [[globulin]] precipitates and blocks the [[urinary tubules]]. <ref name="pmid19841484">{{cite journal| author=Khan FY| title=Rhabdomyolysis: a review of the literature. | journal=Neth J Med | year= 2009 | volume= 67 | issue= 9 | pages= 272-83 | pmid=19841484 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19841484 }} </ref>
== Overview ==
 
=== Study of choice ===
 
* There is no single diagnostic study of choice for the diagnosis of [[myoglobinuria], but [[myoglobinuria]] can be diagnosed based on [[creatine kinase]] (CK) levels to assess for [[rhabdomyolysis]].
*Myoglobin is first enzyme to increase in cases of rhabdomyolysis, but it returns to normal levels within up to 24 hours after the onset of symptoms, because it is rapidly cleared by the kidneys. Serum CK levels remain elevated after serum and urine test results for myoglobin have become negative. CK levels normally peak (1000 U/L) around 3 days after the onset of symptoms, and remain elevated for several days. <ref name="pmid25365815">{{cite journal| author=Lee G| title=Exercise-induced rhabdomyolysis. | journal=R I Med J (2013) | year= 2014 | volume= 97 | issue= 11 | pages= 22-4 | pmid=25365815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25365815 }} </ref>
 
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Creatine Kinase
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Myoglobin
| style="background: #DCDCDC; padding: 5px; text-align: center;" |50%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |50%
|}
 
===== Diagnostic results =====
The following result of [[creatine kinase]](CK) is confirmatory of [[myoglobinuria]], caused my rhabdomyolysis:
* CK 1000 U/L
 
===== Sequence of Diagnostic Studies =====
The [[creatine kinase]] levels should be performed when:
* The patient presented with symptoms/signs of myalgia, muscle weakness, and dark urine as the first step of diagnosis.
* A positive [[creatine kinase]] level is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
*There are no established criteria for the diagnosis of [disease name].


Although both [[myoglobinuria]] and [[hemoglobinuria]] may cause a tea-colored appearance of the urine, and both can cause positive results on the urine dipstick for blood, myoglobinuria can be differentiated from hemoglobinuria by performing the following:
*Myoglobinuria is brown, and only a few RBCs are present in the urine.
*Red or brown urine with a negative dipstick result for blood indicates a dye in the urine. <ref name="pmid19046720">{{cite journal| author=Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD| title=The syndrome of rhabdomyolysis: complications and treatment. | journal=Eur J Intern Med | year= 2008 | volume= 19 | issue= 8 | pages= 568-74 | pmid=19046720 | doi=10.1016/j.ejim.2007.06.037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19046720  }} </ref>


==References==
==References==

Latest revision as of 12:36, 23 August 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

Study of choice

  • There is no single diagnostic study of choice for the diagnosis of [[myoglobinuria], but myoglobinuria can be diagnosed based on creatine kinase (CK) levels to assess for rhabdomyolysis.
  • Myoglobin is first enzyme to increase in cases of rhabdomyolysis, but it returns to normal levels within up to 24 hours after the onset of symptoms, because it is rapidly cleared by the kidneys. Serum CK levels remain elevated after serum and urine test results for myoglobin have become negative. CK levels normally peak (1000 U/L) around 3 days after the onset of symptoms, and remain elevated for several days. [1]

The comparison table for diagnostic studies of choice for [disease name]

Sensitivity Specificity
Creatine Kinase 100% 100%
Myoglobin 50% 50%
Diagnostic results

The following result of creatine kinase(CK) is confirmatory of myoglobinuria, caused my rhabdomyolysis:

  • CK 1000 U/L
Sequence of Diagnostic Studies

The creatine kinase levels should be performed when:

  • The patient presented with symptoms/signs of myalgia, muscle weakness, and dark urine as the first step of diagnosis.
  • A positive creatine kinase level is detected in the patient, to confirm the diagnosis.

Diagnostic Criteria

  • There are no established criteria for the diagnosis of [disease name].


References

  1. ↑ Lee G (2014). "Exercise-induced rhabdomyolysis". R I Med J (2013). 97 (11): 22–4. PMID 25365815.

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