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Clinical features and diagnosis of heme pigment-induced acute kidney injury

Mark A Perazella, MD, FACP
Mitchell H Rosner, MD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD


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" 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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Literature review current through: Nov 2017. | This topic last updated: Aug 02, 2017.
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