Low fractional excretion of sodium. Occurrence with hemoglobinuric- and myoglobinuric-induced acute renal failure

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Abstract
Ten patients with myoglobinuric and hemoglobinuric acute renal failure demonstrated low fractional excretion of Na (FENa) values (< 1%) during the oliguric phase of their course. Acute renal failure secondary to hemoglobinuria developed in 5 patients, and 5 demonstrated acute deterioration with myoglobinuria. The mean serum creatinine level increased from 1.1 mg/dl (range 0.6-1.7 mg/dl) to a maximum of 6.9 mg/dl (range, 2-13.1 mg/dl). Although 3 patients required dialysis, all individuals eventually returned or were returning toward their baseline renal function at discharge. The importance of a low FENa in the setting of myoglobinuric and hemoglobinuric renal failure is reviewed. A common mechanism may underlie the renal injury in both types of pigment toxicity.