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A C-M Lin, C-M Lin, T-L Wang, J-G Leu

Rhabdomyolysis in 119 students after repetitive exercise
Br J Sports Med 2005; 39: e3 [Abstract] [Full text] [PDF]

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Myoglobinuria paradox: Joseph H. Keffer (26 July 2005)

Myoglobinuria paradox

26 July 2005

Joseph H. Keffer,
Physician
University of Texas Southwestern

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Re: Myoglobinuria paradox

jhkeffer{at}earthlink.net Joseph H. Keffer

Dear Editor,

Your diagnosis of rhabdomyolysis appears warranted on the basis of the "dark urine" and "muscle aches combined with massive elevation of creatine kinase. However, I cannot accept the report that there was no myoglobinuria present in these individuals. The urine is dark due to the myoglobin and in view of the CK increase in the thousands, myoglobin must have been present. Many laboratories use outdated and insensitive methods and myoglobin deteriorates fairly rapidly in acidic urine. Immunoassay methods are preferred. Additional relevant references are listed.

1: Wu AH, Laios I, Green S, et al. Immunoassays for serum and urine myoglobin: myoglobin clearance assessed as a risk factor for acute renal failure. Clin Chem. 1994 May;40(5):796-802.

2: Loun B, Astles R, Copeland KR, Sedor FA. Adaptation of a quantitative immunoassay for urine myoglobin. Predictor in detecting renal dysfunction. Am J Clin Pathol. 1996 Apr;105(4):479-86.

3: Chen-Levy Z, Wener MH, Toivola B, et al. Factors affecting urinary myoglobin stability in vitro. Am J Clin Pathol. 2005 Mar;123(3):432-8.