Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Abstract

Rhabdomyolysis due to trauma and burns is an important cause of acute renal failure (ARF) secondary to myoglobinuria. To prevent morbidity and mortality from ARF due to rhabdomyolysis, early detection of ARF by monitoring the biochemical parameters such as serum creatinine, serum creatine kinase (CK), and urinary myoglobin (UM) can be helpful. The aims of the study were (1) to detect ARF due to rhabdomyolysis using serum creatinine, serum CK, and UM in trauma and electrical burn patients (2) to compare utility of these parameters in early prediction of ARF in patients of rhabdomyolysis. A total of 50 patients with trauma and electrical burns were included in the study. Serum creatinine, serum CK, and UM measurements were done at the time of admission and after 48 h. Diagnosis of ARF was made in the patients by Rifle's criteria. The presence of significant elevation of creatinine, serum CK, and UM at the time of admission and after 48 h was compared in patients developing ARF by Fisher's exact test. Fifteen of the 50 patients developed ARF as per the defined criteria. Of these, 9 patients (60%) had raised level of serum creatinine above 1.4 mg% at admission and 14 patients (93.33%) had CK level >1250 U/L at admission, whereas UM was positive in 6 (40%) patients. Serum creatinine was significantly raised in all of the 15 ARF patients (100%) after 48 h of admission and serum CK was raised in 14 of the 15 ARF patients (93.33%). UM was negative in all the patients after 48 h of admission. Statistical analysis showed that rise in serum CK on admission was significantly increased in patients developing ARF as compared with serum creatinine and UM (P<0.0001). On admission, CK is a better predictor of ARF due to rhabdomyolysis than creatinine and UM. Initial creatinine is a better predictor of ARF due to rhabdomyolysis than UM. UM assay is not a good investigation for early prediction of ARF in rhabdomyolysis.

Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

“…Delaney et al recently conducted a retrospective study showing that based on the RIFLE criteria, 59% of the patients with rhabdomyolysis had AKI, most of which were prerenal.35 However, a study by Chen et al found that only 14.4% patients with rhabdomyolysis developed AKI (9). In a recent study of 521 pediatric patients with posttraumatic rhabdomyolysis, AKI occurred in 70 (13.4%) patients (36). In our study based on the AKIN criteria, total of 23 (53.4%) patients developed AKI.…”

“…In a prospective observational study by Bhavsar and colleagues examined 50 patients with rhabdomyolysis due to trauma and electrical burns. They identified a cutoff value of CK 3805 U/L to be 76.5% sensitive and 87.9% specific in predicting AKI after 48 h of injury (36). In another important study performed by Brown et al reviewed the case records of 1771 trauma patients with increased CK levels.…”

Alcohol Induced Rhabdomyolysis

“…The presenting clinical features are myalgia, myoglobinuria, and elevated serum creatine kinase (1)(2)(3). The presence of myoglobin in the urine will produce a dark redbrown pigmentation (3)(4)(5). The function of CK is to convert myocyte creatine phosphate into high-energy phosphate groups (adenosine triphosphate) used in energy requiring reactions (6).…”

“…The function of CK is to convert myocyte creatine phosphate into high-energy phosphate groups (adenosine triphosphate) used in energy requiring reactions (6). Degradation of approximately 200 grams of muscle can cause an increase in serum CK (3,6). When the massive myocyte breakdown of cell membranes occurs, other intracellular constituents are released besides myoglobin and CK (1)(2)(3).…”

“…Degradation of approximately 200 grams of muscle can cause an increase in serum CK (3,6). When the massive myocyte breakdown of cell membranes occurs, other intracellular constituents are released besides myoglobin and CK (1)(2)(3). Approximately 150 grams of muscle necrosis will release more than 15 mmol of potassium (1)(2)(3).…”