Evaluation of Serum Creatine Kinase and Urinary Myoglobin as Markers in Detecting Development of Acute Renal Failure in Severely Injured Trauma Patients

Background. Presence of myoglobinuria, particularly in the early phases of renal failure, and elevation of creatinine kinase are seen to correlate with the development of acute renal failure. Aim. To evaluate the efficiency of serum creatine kinase (CK) and urine myoglobin in assessing development of renal failure. Materials and Method. We prospectively studied trauma patients over a period of 3 months. Samples of 107 patients were routinely analyzed on the 1st, 3rd, and 5th days post trauma, for myoglobinuria and serum CK concentration. Results. 107 patients with median age 28 (4–83)？yrs were studied, of which 83.2% were males. 56% had head injury, and 17.1% had high injury severity (ISS > 24). Incidence of renal failure was 9.3%. Myoglobinuria was present in 57 patients on admission, 33 on 3rd day and 22 on the 5th day. The association of myoglobinuria with renal failure was statistically insignificant. The cutoff values of serum CK on the 1st, 3rd, and 5th days were ≥1320 IU/L, ≥1146 IU/L, and ≥1754 IU/L, respectively. Mortality rate was 24 (22.4%), of which 6 had renal failure. Conclusion. Myoglobin is clinically insignificant in the detection of renal failure; serum CK is a sensitive predicting marker for the progression of renal failure following traumatic injury. 1. Introduction Urine myoglobin and serum creatinine kinase (CK) continue to be used as biomarker of rhabdomyolysis, particularly to assesses risk of developing renal failure. Rhabdomyolysis was first described in the victims of crush injury in Sicilian earthquake in Messina in 1908 and those in World War I. Myoglobin is filtered by the kidney and appears in the urine when the plasma concentration exceeds 1.5？mg/dL. Rhabdomyolysis with renal failure is one of the most serious complications of traumatic patients. We sought to determine the predictive validity of urine myoglobin renal failure in posttraumatic patients. Road traffic accident (RTA)/motor vehicle accident (MVA), crush injury, surgery, and any natural disaster trauma are associated with the release of large amount of myoglobin and serum creatinine kinase (CK) into circulation [1]. At high serum concentrations, myoglobin precipitates in the kidney, both through pigment glomerulopathy and obstructive tubulopathy resulting in renal failure. Creatine phosphokinase (CK) is an enzyme, released into the blood stream on muscle cell disintegration. It exists in three isomeric forms: CK-MM present in muscles, CK-MB present in heart, and CK-BB present in kidneys and brain. Normal range of serum CK in males is 39–308？IU/L and in females