To the Editor.—
I read the article titled "Recurrent Acute Renal Failure With Idiopathic Paroxysmal Myoglobinuria" (233:349-350, 1975) with considerable interest. I would, however, like to call attention to the following entity before considering paroxysmal myoglobinuria as idiopathic.The role of abnormalities of the glycolytic pathways in paroxysmal myoglobinuria is well established and is understandably the primary consideration in the investigation of muscle-cramping syndromes with myoglobinuria. An identical clinical presentation secondary to abnormalities of metabolism of long-chain fatty acids has been described by Engel et al.1 Its identification in a given patient is important in that it offers a mode of therapy with medium-chain triglycerides. Features of this relatively new syndrome are as follows:Often, there is a long history of muscle cramps with or without myoglobinuria. Myoglobinuria, if severe, can impair renal function.2 Prolonged exercise or fasting can precipitate an attack. Ischemic exercise tests performed with blood
Rammohan KW. Myoglobinuria. JAMA. 1976;235(1):24. doi:10.1001/jama.1976.03260270014016
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