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

Abstract

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.