Myoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. Myoglobin (Mb or MB) is an iron- and oxygen-binding protein found in muscles. Myoglobin is present in muscle cells as a reserve of oxygen.In humans, myoglobin is only found in the bloodstream after muscle injury. It is an abnormal finding, and can be diagnostically relevant when found in blood.^[1] Myoglobin is the primary oxygen-carrying pigment of muscle tissues.^[2] High concentrations of myoglobin in muscle cells allow organisms to hold their breath for a longer period of time. Diving mammals such as whales and seals have muscles with particularly high abundance of myoglobin.^[1] Myoglobin is found in Type I muscle, Type II A and Type II B, but most texts consider myoglobin not to be found in smooth muscle.

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• In 1958 John Kendrew and associates announced that they have discovered that Myoglobin was the first protein to have its three-dimensional structure revealed by X-ray crystallography.^[1] .^[2]

• For this discovery, John Kendrew shared the 1962 Nobel Prize in chemistry with Max Perutz.^[3]

• Despite being one of the most studied proteins in biology, its physiological function is not yet conclusively established: mice genetically engineered to lack myoglobin can be viable and fertile but show many cellular and physiological adaptations to overcome the loss. Through observing these changes in myoglobin-deplete mice, it is hypothesised that myoglobin function relates to increased oxygen transport to muscle, oxygen storage and as a scavenger of reactive oxygen species.^[4]

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Myoglobin can take the forms of oxymyoglobin (MbO₂), carboxymyoglobin (MbCO), and metmyoglobin (met-Mb), similarly to different forms of Hemoglobin – oxyhemoglobin (HbO₂), carboxyhemoglobin (HbCO), and methemoglobin (met-Hb).

Normally myoglobin is filtered and excreted with the urine, but if too much myoglobin is released into the circulation from damaged muscle tissue (rhabdomyolysis), which has very high concentrations of myoglobin, it can be toxic to the renal tubular epithelium and so may cause acute kidney injury.^[1] It is not the myoglobin itself that is toxic (it is a protoxin) but the ferrihemate portion that is dissociated from myoglobin in acidic environments (e.g., acidic urine, lysosomes).

Myoglobin is a sensitive marker for muscle injury, making it a potential marker for myocardial infarction in patients with chest pain.^[2] However, elevated myoglobin has low specificity for acute myocardial infarction (AMI) and thus CK-MB, cardiac Troponin, ECG, and clinical signs should be taken into account to make the diagnosis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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After centrifuge, the serum of myologinuria is clear, where the serum of hemoglobinuria after centrifuge is pink.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

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• Myoglobinuria in adults is caused most commonly by trauma, alcohol and drug abuse, usually in relation to muscle necrosis from prolonged immobilization and pressure by the body weight. Protracted consumption of alcohol, seizure activity or vigorous physical activity, can also lead to a disequilibrium between muscle energy consumption and production, resulting in muscle destruction. ^{[1] [2]}
• Myoglobinuria in children and adolescents, is caused most commonly by viral myositis, trauma, exertion, drug overdose, seizures, metabolic disorders, and connective tissue diseases.^[3]

Race

Race is a factor only when natural disasters and economic shortfalls increase the rates of drug and alcohol abuse and the mortality rate among certain racial groups.

Sex

Myoglobinuria tends to affect males more than females because males are more predisposed to trauma and participation in strenuous physical exercise. Persons who exercise and have increased muscle mass have an increased intracellular myoglobin content.

Age

The median age for myoglobinuria is children and adolescents is 11 years. The leading cause of rhabdomyolysis in the 0-9 year age range is viral myositis, whereas the leading cause in the 9-18 year age range is trauma. ^[4]

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No guidelines for screening for myoglobinuria exist.

Natural History Myoglobinuria does not lead to death, unless it is associated with the secondary complications of rhabdomyolysis, including hyperkalemia, hypocalcemia, and acute kidney injury.^[1] However, when it is associated with severe rhabdomyolysis, myoglobinuria-induced acute renal failure is a potentially lethal complication.

Complications’ and Prognosis In adults, myoglobinuria, due to rhabdomyolysis can be complicated by acute kidney injury, that requires hemodyalisis. In children, renal failure and acute kidney injury are also the most common complications.