Rhabdomyolysis and Acute Kidney Injury due to Severe Heat Stroke
Table 1
Differential diagnosis of pigmenturia.
Hematuria
Hemoglobinuria
Myoglobinuria
Bile pigments
Porphyria
Alkaptonuria
Pigment
RBC*
Hemoglobin
Myoglobin
Bilirubin/Urobilin
Porphobilinogen
Homogentisinic acid
Urine color
Red
Pink
Red to brown
Brown
Turns brown, red, purple or black on standing at sunlight. Fluoresces with UV light
Turns dark in alkaline solutions. Darkens on standing at sunlight.
Urine Sedi-ment***
RBC and RBC casts
Normal**
Normal
Normal
Normal
Normal
Supernatant urine color
Yellow
Red to brown
Red to brown
Brown
Red. (Watson-Schwartz test positive)
Normal (Ferric chloride test positive)
Urine dipstick test****
1 to 4 +
1 to 4 +
1 to 4 +
Normal
Normal
Normal
Serum
Normal
Pink (low haptoglobin)
Normal (increase ofmyoglobin,creatinine kinase, and liverenzymes inrhabdomyolysis)
Icteric
Normal
Normal
Muscle symptoms
No
No
Myalgias
No
Abdominal cramps.
No (ochronosis and arthritis)
*RBC red blood cells.
**Normal refers to white or yellow in color.
***The sediment and supernatant urine examined after centrifugation.
****Semiquantitative test (orthotolidine or peroxidase) detects heme peroxidase activity in RBC, hemoglobin or myoglobin with reported sensitivity of 91–100%. (1 + = 5–10 RBC/μL, 4+ = approx. 250 RBC/μL).