Myoglobinuria in Autopsy Pathology: Relevant and Potentially Unrecognized

Melissa M. Blessing, R. Ross Reichard, Joseph J. Maleszewski, Mariam P. Alexander

Research output: Contribution to journalArticlepeer-review


Background: Myoglobin-related renal injury (MRRI) is a significant cause of acute renal injury and may result in death. Common etiologies in forensic pathology include trauma and drug abuse. This study sought to determine the prevalence and causes of MRRI at autopsy and discuss diagnostic challenges. Methods: The institutional autopsy archives were queried for cases in which a myoglobin (MG) immunohistochemical stain was performed or MRRI was diagnosed or considered. The clinicopathological characteristics of this population were described. Results: Of 9996 cases over a period of 19.5 years, 17 cases (0.2%) fulfilled the criteria. Patient age ranged from 15 to 74 years; 11 were men. The MG stain was performed in 13 cases. In 11 (65%) cases, MRRI was diagnosed with or without immunohistochemistry. The clinical backgrounds were varied; sepsis and liver injury predominated. Time between original insult and death ranged from seven hours to four months. Patterns of MRRI included cast formation or fine brush border staining in the proximal tubules. Discussion: MRRI is infrequently considered in the autopsy setting. Many causes of MRRI identified in this series involved circumstances placing the death into medical examiner jurisdiction; the MG stain contributed to understanding the mechanism of death. Acute tubular injury with cast formation was observed in the majority of cases. Conclusion: MRRI is common in a select group of autopsies but may be underappreciated. The MG stain is a useful and inexpensive tool to aid in the diagnosis of MRRI in autopsy pathology.

Original languageEnglish (US)
Pages (from-to)226-234
Number of pages9
JournalAcademic Forensic Pathology
Issue number2
StatePublished - Jun 1 2014


  • Forensic pathology
  • Myoglobin
  • Myoglobin-related renal injury
  • Myoglobinuria

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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