Clinical features and diagnosis of heme pigment-induced acute kidney injury (acute renal failure)
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
Acute kidney injury (AKI) can occur in patients who have rhabdomyolysis and, less commonly, in patients with hemolysis [1,2]. In both groups, AKI is caused by the nonprotein heme pigment that is released from either myoglobin or hemoglobin and is toxic to the kidney. Hypovolemia may contribute in patients with rhabdomyolysis due to crush injury.
The clinical features and diagnosis of heme pigment-induced AKI due to nontraumatic rhabdomyolysis and to hemolysis will be reviewed here. Prevention and treatment of heme pigment-induced AKI, AKI due to crush injury, and overviews of rhabdomyolysis and hemolysis are discussed separately. (See "Prevention and treatment of heme pigment-induced acute kidney injury (acute renal failure)" and "Crush-related acute kidney injury (acute renal failure)" and "Clinical manifestations and diagnosis of rhabdomyolysis" and "Diagnosis of hemolytic anemia in the adult".)
Heme pigment-containing proteins include myoglobin and hemoglobin. Myoglobin is released from muscle in patients with traumatic or nontraumatic rhabdomyolysis, whereas hemoglobin is released from hemolyzed red blood cells. Both myoglobin and hemoglobin are filtered by the glomerulus into the urinary space where they are degraded, thus releasing heme pigment.
Heme pigment may injure the kidney in three ways:
●Tubular obstruction, possibly in association with uric acid [1,3]
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- Causes of rhabdomyolysis
- - Risk prediction score for severe acute kidney injury or death
- Causes of hemolysis
- CLINICAL MANIFESTATIONS
- Other laboratory findings
- - Creatine kinase
- - Potassium
- - Calcium
- - Phosphate
- - Creatinine-to-urea ratio
- - Transaminases
- - Other