Received on April 17, 2009
Accepted on September 9, 2009

Evidence-Based Medicine and Test Utilization

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Subjects Where Rhabdomyolysis Is Suspected: A Systematic Review

¹ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
² Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada, and Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada

BACKGROUND: Urine myoglobin continues to be used as a marker of rhabdomyolysis, particularly to assess risk of developing acute renal failure and evaluate treatment success. We sought to determine the predictive validity of urine myoglobin (uMb) for acute renal failure (ARF) in patients with suspected rhabdomyolysis.

METHODS: We performed a broad systemic review of the literature from January 1980 to December 2006 using the search terms myoglobin$ AND (renal OR ARF OR kidney). Only primary studies published in English where uMb measurement was related to ARF were included.

RESULTS: Of 1602 studies screened, 52 met all selection criteria. The studies covered a wide spectrum of etiologies for rhabdomyolysis, dissimilar diagnostic criteria for ARF and rhabdomyolysis, and various methods of uMb measurement and were mostly case series (n = 32). There was poor reporting on the uMb method, and 17 studies failed to provide any information about the method. The reporting of clinical criteria for ARF with respect to timing, description, performance, and interpretation also lacked adequate detail for replication. Eight studies (total 295 patients) had data for 2-by-2 tables. Sensitivity of the uMb test was 100% in 5 of the 8 studies, specificity varied widely (15% to 88%), and CIs around these measures were high. Pooling of data was not possible because of study heterogeneity.

CONCLUSIONS: There is inadequate evidence evaluating the use of uMb as a predictor of ARF in patients with suspected rhabdomyolysis.