Myoglobinuria: Causes, Treatment & Help

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

What is myoglobinuria?

The term myoglobinuria identifies an increased concentration of myoglobin in the urine. Myoglobin is a globin that, like hemoglobin in the blood, is responsible for transporting oxygen within muscle cells. Structurally, it also resembles hemoglobin. It takes the oxygen of hemoglobin from the blood and transports it inside the muscle cell to the mitochondria. There, with the help of the released oxygen, combustion processes take place to generate energy. Myoglobin is a single-chain protein consisting of 153 amino acids. Like hemoglobin, its structure enables it to bind and release oxygen reversibly. Its molecular mass is quite small, 17,053 daltons, so it can be easily excreted by the kidneys when released. Myoglobin is found only in the skeletal and cardiac muscle cells of mammals. When there is increased breakdown of muscle cells, it is released and can then lead to myoglobinemia (increased concentration of myoglobin in the blood) and myoglobinuria. The breakdown of cardiac and skeletal muscle is also known as rhabdomyolysis. Rhabdomyolysis can have several causes. The resulting greatly increased concentration of myoglobin in the urine can cause damage to the kidneys and must be treated.

Causes

As mentioned earlier, the cause of myoglobinuria is increased breakdown of muscle cells, with single-chain protein molecules first entering the blood and from there into the urine. However, muscle breakdown or rhabdomyolysis can in turn have different causes. First, a distinction is made between traumatic and nontraumatic causes. Traumatic causes are considered to be muscle injuries caused by external impact. For example, muscle fibers injured in an accident can dissolve and trigger the so-called cush syndrome. In cush syndrome, myoglobin levels in the blood and urine rise to such an extent that liver and kidney failure can result. Injury and disintegration of muscle cells can also occur after electric shocks, seizures, surgery, when there is high pressure on the muscles, or when lying down for long periods of time. Non-traumatic causes of muscle dissolution include heart attack, certain viral infections, electrolyte imbalances, hyperthermia, alcohol excess, poisoning with medications and drugs. Also muscle inflammation, autoimmune diseases, metabolic disorders, hormonal disorders, blood disorders, and snake or mushroom poisoning. The most dangerous complication of rhabdomyolysis and consequent myoglobinuria is renal failure. Myoglobin can lead to kidney damage in three ways. The heme can form urinary sediment, thereby obstructing the renal tubules. Furthermore, tubule cell damage is possible due to released iron. Finally, the shift of fluid into the damaged muscle leads to reduced blood flow to the kidneys.

Diseases with this symptom

  • Liver failure
  • Drug addiction
  • Heart attack
  • Metabolic disorder
  • Kidney weakness
  • Alcohol addiction
  • Poisoning
  • Hormonal imbalances
  • Heart attack
  • Electrolyte disturbance
  • Muscle inflammation
  • Autoimmune disease

Diagnosis and course

Myoglobinuria is a symptom of underlying resolution of transverse striated muscle. It represents a sensitive indicator of myoglobinemia. It can be recognized by a reddish-brown discoloration of the urine. In severe cases, myoglobinuria can be the starting point for extensive kidney damage. This applies, among other things, to the so-called Cush syndrome. Cush syndrome is caused by a severe injury to the skeletal muscles in an accident. This leads to the death of muscle cells, which results in both myoglobinemia and myoglobinuria. Cush syndrome results in fulminant renal and hepatic failure. It is also referred to as cush kidney. The kidney tissue perishes due to necrotic processes.Without treatment, this extremely serious complication quickly leads to death. Even in milder forms of myoglobinuria, kidney damage can develop in the long term. Therefore, the concentration of myoglobin in the urine should be reduced as part of therapy. Laboratory tests of the urine and blood are performed to diagnose myoglobinuria. The urine turns reddish brown. The underlying rhabdomyolysis is detected by elevated levels of creatine kinase (CK) and lactate dehydrogenase (LDH) in the blood. Furthermore, elevated levels of myoglobin are also measured in the blood.

When should you see a doctor?

Myoglobinuria must be evaluated and treated by a physician. If treatment is not received, in the worst case scenario, the kidneys can be damaged. This damage is usually irreversible, and the affected person is then dependent on dialysis or a donor organ to continue to survive. The discomfort of myoglobinuria is seen by a red colored urine. If this complaint occurs, a doctor must be consulted in any case. Especially after an accident, damage to the skeleton of the affected person may result in myoglobinuria. If the patient has also suffered an accident before, medical treatment is also necessary. In most cases, this also results in fever and a general feeling of illness in the patient. If the patient continues to experience discomfort in the liver, the disease may be more advanced. In this case, urgent treatment by a physician is necessary.

Treatment and therapy

There is otherwise no causative therapy for myoglobinuria. Thus, attempts are always made to prevent the precipitating factors for muscle disintegration. However, to prevent renal damage, measures must be taken to reduce the concentration of myoglobin in the urine. This can be achieved with forced diuresis. Diuresis involves increasing the excretion of urine by the kidneys. Among other things, diuretic agents are administered for this purpose. The patient receives infusions containing so-called loop diuretics. Loop diuretics are diuretic drugs that act directly on the loop of Henle in the kidneys. They provide accelerated excretion and dilution of myoglobin in the urine. In addition, to prevent precipitation of myoglobin, the urine is made alkaline. In very severe cases, the blood must be cleansed of myoglobin by dialysis.

Outlook and prognosis

Untreated myoglobinuria can cause severe damage to the kidneys. These are usually not reversible, so severe complications can arise for the patient. Similarly, severe injury or damage to skeletal muscle occurs due to muscle breakdown. In some cases, the liver may also be affected and damaged by myoglobinuria. The complications to the kidneys can lead to death in the worst cases if no treatment is given. Medications are usually used to treat the conditions affecting the kidneys and to stop the breakdown of the muscles. Since the causes of myoglobinuria are relatively diverse, no general prognosis can be given here about the success of this disease. If it has occurred due to excessive consumption of alcohol or other drugs, the addictive substances must be discontinued or withdrawal must be carried out. Myoglobinuria also causes inflammation of the muscles and metabolic disorders in many cases.

Prevention

Because myoglobinuria can be caused by a variety of causes, there are no universal recommendations for its prevention. However, a healthy lifestyle can reduce the risk of developing the disease. This includes, among other things, refraining from excessive use of medications, drugs or alcohol. But strengthening the immune system also helps reduce the risk of triggering infectious diseases.

Here’s what you can do yourself

In any case, myoglobinuria should first be clarified medically. Accompanying medical treatment, the complaints and symptoms can be treated by various home remedies and self-help tips. Thus, in addition to medical diuresis, diuretic preparations and plants can be taken to regulate the concentration of myoglobin in the urine. Dandelion and burdock root, for example, are said to have a diuretic effect.Both plants can be taken as a tea or in the form of appropriate supplements after consultation with the doctor and help to alleviate myoglobinuria. Once myoglobin concentration has been successfully regulated, preventive measures must be taken. A healthy lifestyle and avoidance of stimulants as well as medications and drugs significantly reduce the risk of developing the disease. In general, the immune system should be strengthened so that triggering infectious diseases cannot develop in the first place. However, if myoglobinuria occurs again, it is important to talk to your family doctor. There may be an underlying disease or a previously unknown trigger that must be diagnosed quickly and treated if necessary. Early medical evaluation can reliably prevent progression of myoglobinuria.