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Myoglobinuria Rhabdomyolysis — ESENeph MCQ

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EasyAcute Kidney InjuryMyoglobinuria RhabdomyolysisESENeph

A 40-year-old man presents with AKI after hiking in extreme heat. He is severely dehydrated. Creatinine is 350 umol/L, CK 2500 U/L (mildly elevated), urine is dark and concentrated. Urine dipstick is positive for blood but microscopy shows no red cells. What does this finding indicate?

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Correct answer: D — Myoglobinuria – the urine dipstick detects myoglobin (cross-reacts with haem on dipstick)

Urine dipstick positive for 'blood' without red cells on microscopy indicates myoglobinuria (or haemoglobinuria). The dipstick haem pad cannot distinguish haemoglobin from myoglobin. In the context of dehydration, exertion, and elevated CK (even modestly), rhabdomyolysis with myoglobinuria is the diagnosis. Myoglobin is directly nephrotoxic and causes AKI through tubular obstruction, oxidative injury, and vasoconstriction. Treatment is aggressive IV fluid resuscitation with isotonic saline targeting urine output >200-300 mL/hr.

Reference: KDIGO 2012 – AKI; Bosch et al 2009 – Rhabdomyolysis