Myoglobinuria represents an increased concentration of myoglobin in urine and is a characteristic parameter for myoglobinemia. High levels of myoglobin in the urine can damage the kidneys. The cause of myoglobinuria is the increased breakdown of muscle cells in the context of various diseases.

What is a myoglobinuria?

Myoglobinuria is a symptom of underlying dissolution of the striated muscle. It is a sensitive indicator of myoglobinemia.
© Henrik Dolle - stock.adobe.com

The term myoglobinuria indicates an increased concentration of myoglobin in the urine. Myoglobin is a globin, which is similar to the hemoglobin in the blood responsible for the transport of oxygen within the muscle cells. Structurally, it also resembles hemoglobin. It takes the oxygen of hemoglobin from the blood and transports it into the interior of the muscle cell to the mitochondria.

There then take place using the emitted oxygen combustion processes for energy production. Myoglobin is a single-chain protein consisting of 153 amino acids. Due to its structure like hemoglobin, it has the ability to reversibly bind and release oxygen. Its molecular mass of 17, 053 daltons is rather small, so it can easily be excreted via the kidneys when released.

Myoglobin occurs only in the skeletal and cardiac muscle cells of mammals. Increased muscle cell depletion releases it and can then lead to myoglobinemia (increased levels of myoglobin in the blood) and myoglobinuria. The decomposition of heart and skeletal muscle is also referred to as rhabdomyolysis. Rhabdomyolysis can have various causes. The resulting high concentration of myoglobin in the urine can damage the kidneys and must therefore be treated.

causes

As already mentioned, the cause of myoglobinuria is the increased breakdown of muscle cells, whereby the single-chain protein molecules first get into the blood and from there into the urine. However, muscle breakdown or rhabdomyolysis can have different causes. At first a distinction is made between traumatic and non-traumatic reasons.

Traumatic causes include muscle injuries caused by external influences. For example, accidentally injured muscle fibers can dissolve and cause the so-called Cush syndrome. As a result of Cush syndrome, myoglobin levels in blood and urine increase so much that liver and kidney failure can occur.

Injuries and disintegration of muscle cells can also occur after electric shocks, seizures, operations, with high pressure on the muscles or during long lying. Non-traumatic causes of muscle breakdown include heart attack, certain viral infections, electrolyte imbalances, hyperthermia, alcohol excesses, medication and drug poisoning.

Also muscle inflammation, autoimmune diseases, metabolic diseases, hormonal disorders, blood disorders and snakes or fungal poisoning. The most dangerous complication of rhabdomyolysis and consequent myoglobinuria is renal failure.

Myoglobin can cause kidney damage in three ways. The heme can form urine sediments and block the kidney tubules. Furthermore, damage to the tubule cells due to released iron is possible. Finally, the fluid shift in the damaged muscle leads to a reduced blood flow to the kidneys.

Diseases with this symptom

  • liver failure
  • drug addiction
  • Heart attack
  • Metabolic disorder
  • kidney failure
  • alcohol addiction
  • poisoning
  • hormonal imbalances
  • Heart attack
  • electrolyte imbalance
  • muscle inflammation
  • Autoimmune disease

Diagnosis & History

Myoglobinuria is a symptom of underlying dissolution of the striated muscle. It is a sensitive indicator of myoglobinemia. It is recognizable by a reddish-brown discoloration of the urine. In severe cases, myoglobinuria may be the starting point for extensive kidney damage.

This applies among other things to the so-called Cush syndrome. Cush syndrome is based on a severe skeletal muscle injury in an accident. This leads to the death of the muscle cells, resulting in both myoglobinemia and myoglobinuria. Cush syndrome causes fulminant kidney and liver failure.

It is also spoken by the so-called Cush kidney. The kidney tissue is caused by necrotic processes. Without treatment, the extremely serious complication quickly leads to death. Even mild forms of myoglobinuria can cause long-term kidney damage. Therefore, as part of a therapy, the concentration of myoglobin in the urine should be lowered.

To diagnose a myoglobinuria, laboratory examinations of urine and blood are performed. The urine turns reddish brown. The underlying rhabdomyolysis is detected by elevated levels of creatine kinase (CK) and lactate dehydrogenase (LDH) in the blood. In addition, elevated levels of myoglobin are also measured in the blood.

When should you go to the doctor?

The myoglobinuria must be examined and treated by a doctor. If it does not come to a treatment, in the worst case the kidneys can be damaged. These damages are usually irreversible and the person is then dependent on dialysis or on a donor organ to continue to survive.

The complaints of myoglobinuria are visible through a red colored urine. If it comes to this complaint, it must be consulted in any case a doctor. Especially after an accident, it can cause damage to the skeleton of the affected person, which have the myoglobinuria result. If the patient has previously suffered an accident, medical treatment is also required. In most cases, it also comes to fever and a general feeling of illness of the patient. If it also continues to cause liver problems, the disease may be even more advanced. In this case, urgent treatment by a doctor is necessary.

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Treatment & Therapy

There is no causal therapy for myoglobinuria otherwise. So it is always trying to prevent the triggering factors for muscle resolution. However, measures to reduce urinary myoglobin levels must be taken to prevent kidney damage. This can be achieved with a forced diuresis.

Diuresis increases urinary excretion via the kidneys. For this purpose, among other diuretic drugs are administered. The patient receives infusions containing so-called loop diuretics. Loop diuretics are diuretic drugs that act directly on Henlesche's kidney loop.

They provide for the accelerated excretion and dilution of myoglobin in the urine. In addition, to prevent myoglobin from precipitating, urine is rendered alkaline. In very severe cases, the blood must be cleared by dialysis of myoglobin.

Outlook & Forecast

Untreated myoglobinuria can cause severe damage to the kidneys. As a rule, these are not reversible, which can cause serious complications for the patient. Likewise, there is severe injury or damage to the skeletal muscle due to the breakdown of muscles.

In some cases, the liver may also be affected by myoglobinuria and be damaged. Kidney complications can, in the worst case scenario, result in death if no treatment is given. In order to treat the diseases of the kidneys and stop the breakdown of the muscles, drugs are usually used.

Since the causes of myoglobinuria are relatively diverse, no general prognosis can be given about the success of this disease. If it has been due to the excessive consumption of alcohol or other drugs, the addictive substances must be discontinued or a withdrawal carried out.

Myoglobinuria also causes inflammation of the muscles and metabolic diseases in many cases.

prevention

Since myoglobinuria can be caused by a variety of causes, there are no generally accepted recommendations for its prevention. However, a healthy lifestyle can reduce the risk of getting a disease. Among other things, this includes the renunciation of excessive use of drugs, drugs or alcohol. But strengthening the immune system also helps reduce the risk of triggering infectious diseases.

You can do that yourself

Myoglobinuria should always be medically clarified first. Accompanying the medical treatment, the symptoms and symptoms can be treated by various home remedies and self-help tips.

Thus, in addition to the medical diuresis, diuretic preparations and plants can be taken to regulate the myoglobin concentration in the urine. A diuretic effect is said about the dandelion and burdock root. Both plants can be taken after consultation with the doctor as tea or in the form of appropriate supplements and help in the relief of myoglobinuria.

Once the myoglobin concentration has been successfully regulated, preventive measures must be taken. A healthy lifestyle and the absence of stimulants, drugs and drugs reduce the risk of illness significantly. In general, the immune system should be strengthened, so that triggering infectious diseases can not even arise.

Should it come again to a myoglobinuria, must be spoken to the family doctor. There may be an underlying disease or a previously unknown trigger that must be diagnosed quickly and treated if necessary. An early medical check-up can reliably prevent the progression of myoglobinuria.

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