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).