Strenuous exercise, including marathon running, can result in damage to skeletal muscle cells, a process known as exertional rhabdomyolysis. In most cases, this damage is resolved without consequence. However, when the damage is profound, there is a release of muscle proteins into the blood; one of these proteins, myoglobin, in high concentrations and under certain conditions (such as dehydration and heat stress) can precipitate in the kidneys, thereby resulting in acute renal failure. Although the marathon is a gruelling physiological challenge, with races sometimes run in hot and humid weather, acute renal failure is relatively infrequent. From case reports, a high proportion of marathon runners who developed acute renal failure had taken analgesics, had a viral or bacterial infection, or a pre-existing condition. The rare cases of acute renal failure in marathon runners may be a situation of the ‘perfect storm’ where there are several factors (heat stress, dehydration, latent myopathy, non-steroidal anti-inflammatory or other drug/analgesic use, and viral/bacterial infection) that, in some combination, come together to result in acute renal failure.
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Clarkson PM, Hubal MJ. Exercise-induced muscle damage in humans. Am J Phys Med Rehabil 2002; 81: 552–69
Clarkson PM, Kearns AK, Ronner P, et al. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc 2006; 38: 623–7
Clarkson PM, Eichner ER. Exertional rhabdonryolysis: does elevated blood creatine kinase foretell renal failure? Curr Sports Med Rep 2006; 5: 57–60
Seedat YK, Aboo N, Naicker S, et al. Acute renal failure in the “Comrades Marathon” runners. Ren Fail 1989; 11: 209–12
Schiff HB, MacSearraigh ET, Kallmeyer JC. Myoglobinmia, rhabdomyolysis and marathon running. Q J Med 1978; 47: 463–72
MacSearraigh ET, Kallmeyer JC, Schiff HB. Acute renal failure in marathon runners. Nephron 1979; 24: 236–40
Vining KE, Nichols NJ, Seligson GR. Naproxen and acute renal failure in a runner [letter]. Ann Intern Med 1986; 105: 144
Lonka L, Pedersen RS. Fatal rhabdomyolysis in marathon runner. Lancet 1987; I: 857–8
Boyd JF. Fatal rhabdomyolysis in a marathon runner. Lancet 1987; 1: 1089
Reid WA, McQueen A. Acute rhabdomyolysis in a marathon runner [letter]. Br J Sports Med 1987; 21: 49
Farquhar B, Kenney LW. Anti-inflammatory drugs, kidney function, and exercise. Sports Science Exchange 1997; 11: 1–5
Testa M, Navazio FM, Neugebauer J. Recognition, diagnosis, and treatment of mitochondrial myopattues in endurance athletes. Curr Sports Med Rep 2005; 4: 282–7
Ratliff NB, Harris KM, Smith SA, et al. Cardiac arrest in a young marathon runner. Lancet 2002; 360: 542
Priscilla M. Clarkson is a consultant to the Gatorade Sports Science Institute and a contracted researcher for Quaker and Medinova.
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Clarkson, P.M. Exertional Rhabdomyolysis and Acute Renal Failure in Marathon Runners. Sports Med 37, 361–363 (2007). https://doi.org/10.2165/00007256-200737040-00022
- Heat Stress
- Creatine Kinase
- Acute Renal Failure
- Muscle Protein
- Disseminate Intravascular Coagulation