Which mechanisms caused by circulating myoglobin can lead to the development of kidney failure? (Select all that apply.)
a. Dark tea-color urine
b. Decreased renal perfusion
c. Cast formation with tubular obstruction
d. Administration of diuretics
e. Rapid screening for serum creatine kinase level
f. Toxic effects of myoglobin in the kidney tubules
B, C, F
Circulating myoglobin can lead to the development of kidney failure by three mechanisms: decreased renal perfusion, cast formation with tubular obstruction, and direct toxic effects of myoglobin in the kidney tubules. Dark tea-colored urine suggests myoglobinuria. The most rapid screening test is a serum creatine kinase level. Urine output and serial creatine kinase levels should be monitored. Alkalinization of the urine and administration of diuretics have been studied, but their roles in the prevention or management of rhabdomyolysis are not firmly established.
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