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Renal injury in sport

  • Published:
Current Sports Medicine Reports

Abstract

Hematuria is the most common presenting sign of renal injury. Its presence in athletes may indicate a benign entity such as exercise-induced hematuria or a more serious injury in the presence of trauma. Exercise-induced hematuria can originate in the kidney, bladder, urethra, or prostate. The type of activity, as well as activity duration and intensity, contributes to its development. A wide differential diagnosis must be considered if hematuria persists longer than 24 to 72 hours. Trauma to the kidney can occur from a direct blow or deceleration; contact and collision sports are most commonly involved. Fortunately, most sports-related renal trauma is mild, and can be managed expectantly. A sporting injury rarely results in nephrectomy. Determining return to play for the athlete with a single kidney remains a controversial issue that requires patient education and an individualized approach.

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References and Recommended Reading

  1. Gardner KD: Athletic pseudonephritis alteration of urine sediment by athletic competition. JAMA 1956, 161:1613–1617.

    Article  Google Scholar 

  2. Boileau M, Fuchs E, Barry JM, Hodges CV: Stress hematuria: athletic pseudonephritis in marathoners. Urology 1980, 15:471–474.

    Article  CAS  PubMed  Google Scholar 

  3. Brieger GH: The diseases of runners: a view from the eighteenth century-a commentary. Pharos 1980, 43:29–32.

    CAS  PubMed  Google Scholar 

  4. Barach JH: Physiological and pathological effects of severe exertion on the circulatory and renal systems. Arch Intern Med 1910, 5:382–405.

    Article  Google Scholar 

  5. Froom P, Ribak J, Benbassat J: Significance of microhematuria in young adults. BMJ 1984, 288:20–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Mohr DN, Offord KP, Owen RA, Melton J: Asymptomatic microhematuria and urological disease. J Osteopath Sports Med 198, 256:224–229.

  7. Mariani AJ, Mariani MC, Macchioni C, et al.: The significance of adult hematuria: 1000 hematuria evaluations including a risk benefit and cost effective analysis. J Urol 1989, 141:350–355.

    CAS  PubMed  Google Scholar 

  8. Alyea EP, Parish HH: Renal response to exercise-urinary findings. JAMA 1958, 167:807–813.

    Article  CAS  Google Scholar 

  9. Amelar RD, Solomon C: Acute renal trauma in boxers. J Urol 1954, 72:145.

    CAS  PubMed  Google Scholar 

  10. Jones GR, Newhouse IJ, Jakobi JM, et al.: The incidence of hematuria in middle distance track running. Can J Appl Physiol 2001, 26:336–349. A well-designed and recent study specifically targeting the incidence of hematuria and causative factors, including intensity of exercise.

    Article  CAS  PubMed  Google Scholar 

  11. Castenfors J: Renal function during prolonged exercise. Ann NY Acad Sci, 1977, 301:151–159.

    Article  CAS  PubMed  Google Scholar 

  12. Barclay JA, Cooke WT, Kenney RA, Nutt, ME: The effects of water diuresis and exercise on the volume and composition of the urine. Am J Physiol 1947, 148:327.

    CAS  PubMed  Google Scholar 

  13. Blacklock NJ: Bladder trauma in the long distance runner: "10,000 metres haematuria." Br J Urol 1977, 49:129–132.

    Article  CAS  PubMed  Google Scholar 

  14. Abarbanel J, Benet AE, Lask D, Kimche D: Sports hematuria. J Urol 1990, 143:887–890.

    CAS  PubMed  Google Scholar 

  15. Cianflocco AJ: Renal complications of exercise. Clin Sports Med 1992, 11:437–451.

    CAS  PubMed  Google Scholar 

  16. LeRoy JB: Banana-seat hematuria. N Engl J Med 1972, 287:311.

    CAS  PubMed  Google Scholar 

  17. Jones GR, Newhouse I: Sport-related hematuria: a review. Clin J Sport Med 1997, 7:119–125.

    Article  CAS  PubMed  Google Scholar 

  18. Ubels FL, van Essen GG, nde Jong PE, Stegeman CA: Exercise induced macroscopic haematuria: run for a diagnosis? Nephrol Dial Transplant 1999, 14:2030–2031.

    Article  CAS  PubMed  Google Scholar 

  19. Gerth J, Ott U, Funfstuck R, et al.: The effects of prolonged physical exercise on renal function, electrolyte balance and muscle cell breakdown. Clin Nephrol 2002, 57:425–431. The most recent study reporting on exercise-induced hematuria, also concluding that the hematuria is more strongly related to intensity of exercise than duration.

    Article  CAS  PubMed  Google Scholar 

  20. Restrepo NC, Carey PO: Evaluating hematuria in adults. Am Fam Physician 1989, 40:149–156.

    CAS  PubMed  Google Scholar 

  21. Kraus SE, Siroky MB, Babayan RK, Krane RJ: Hematuria and the use of nonsteroidal anti-inflammatory drugs. J Urol 1984, 132:288–290.

    CAS  PubMed  Google Scholar 

  22. Eichner ER: Hematuria-a diagnostic challenge. Physician Sportsmed 1990, 18:53–63.

    Google Scholar 

  23. Arm JP, Peile EB, Rainford DJ, et al.: Significance of dipstick hematuria: part 1. Br J Urol 1986, 58:211–217.

    Article  CAS  PubMed  Google Scholar 

  24. Gambrell RC, Blount BW: Exercise-induced hematuria. Am Fam Physician 1996, 53:905–911.

    CAS  PubMed  Google Scholar 

  25. Emanuel B, Weiss H, Gollin P: Renal trauma in children. J Trauma 1977, 17:275–278.

    Article  CAS  PubMed  Google Scholar 

  26. Persky L, Forsythe W: Renal trauma in childhood. JAMA 1962, 132:709–712.

    Article  Google Scholar 

  27. Reid IS: Renal trauma in children: a ten year review. Aust N Z J Surgery 1973, 42:260–266.

    Article  CAS  Google Scholar 

  28. Amaral J: Primary Care of the injured athlete, Part II: Thoracoabdominal injuries in the athlete. Clin Sports Med 1997, 16:739–753.

    Article  CAS  PubMed  Google Scholar 

  29. Bergqvist D, Hedelin H, Karlsson G, et al.: Abdominal injury from sporting activities. Br J Sports Med 1982, 16:76–79.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Chopra P, St-Vil D, Yazbeck S: Blunt renal trauma: blessing in disguise? J Pediatr Surg 2002, 37:779–782.

    Article  PubMed  Google Scholar 

  31. Kusmarov IW, Morehouse DD, Gibson S: Blunt renal trauma in the pediatric population: a retrospective study. J Urol 1981, 126:648–649.

    Google Scholar 

  32. Diamond D: Sports-related abdominal trauma. Clin Sports Med 1989, 8:91–99.

    CAS  PubMed  Google Scholar 

  33. Santucci R, McAninch J: Diagnosis and management of renal trauma: past, present, and future. J Am Coll Surg 2000, 191:443–451. A good review of recent changes in renal injury management, including algorithm to guide surgical or conservative management.

    Article  CAS  PubMed  Google Scholar 

  34. Peterson NE: Genitourinary trauma. In Trauma, edn 3. Edited by Feliciano DV, Moore EE, Mattox KL. Stamford: Appleton and Lange; 1996:661–693.

    Google Scholar 

  35. Bux S, Tarry W, Zaslau S: Contemporary management of renal trauma. West Virginia. Med J 2002, 9B:152–155.

    Google Scholar 

  36. Harris A, Zwirewich CV, Lyburn ID, et al.: CT findings in blunt renal trauma. Radiographics 2001, 21:S201-S214. Excellent compilation of CT findings and pictoral representations of grades of renal injury.

    Article  PubMed  Google Scholar 

  37. Kawashima A, Sandler CM, Corl FM, et al.: Imaging of renal trauma: a comprehensive review. Radiographics 2001, 21:557–574.

    Article  CAS  PubMed  Google Scholar 

  38. Sandler CM, Amis ES, Bigongiari LR, et al.: Diagnostic approach to renal trauma. Radiology 2000, 215(Suppl):727–731.

    Article  PubMed  Google Scholar 

  39. Brown SL, Haas C, Dinchman KH, et al.: Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. World J Surg 2001, 25:1557–1560.

    Article  CAS  PubMed  Google Scholar 

  40. Perez-Bayfield MR, Gatti JM, et al.: Blunt traumatic hematuria in children. Is a simplified algorithm justified? J Urol 2002, 167:2543–2547. An interesting retrospective review recommending a more selective use of CT scanning in pediatric patients with renal injury, with accompanying editorial comments on this controversial issue.

    Article  Google Scholar 

  41. Santucci RA, McAninch JW, et al.: Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma Inj Infec Crit Care 2001, 50:195–200. A large retrospective review that validates the clinical usefulness of the AAST grading scale in guiding management of renal injury.

    Article  CAS  Google Scholar 

  42. Anderson CR: Solitary kidney and sports participation. Arch Fam Med 1995, 4:885–888.

    Article  CAS  PubMed  Google Scholar 

  43. Mandell J, Cromie WJ, Caldamone AA, et al.: Sports related genitourinary injuries in children. Clin Sports Med 1982, 1:483–493.

    CAS  PubMed  Google Scholar 

  44. Dorsen PJ: Should athletes with one eye, kidney or testicle play contact sports? Physician Sportsmed 1986, 14:130–138.

    Google Scholar 

  45. Wichmann S, Martin DR: Single-organ patients: balancing sports with safety. Physician Sports Med 1992, 20:176–182.

    Article  Google Scholar 

  46. Risser WL, Anderson SJ, Bolduc SP, et al.: Medical conditions affecting sports participation. Pediatrics 1994, 94:757–760.

    Google Scholar 

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Authors and Affiliations

  1. Ball Memorial/Central Indiana Sports Medicine, 3600 West Bethel Avenue, 47304, Muncie, IN, USA

    F. Clarke Holmes MD, Jeremy J. Hunt MD, ATC & Thomas L. Sevier MD

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  1. F. Clarke Holmes MD
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  2. Jeremy J. Hunt MD, ATC
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  3. Thomas L. Sevier MD
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Holmes, F.C., Hunt, J.J. & Sevier, T.L. Renal injury in sport. Curr Sports Med Rep 2, 103–109 (2003). https://doi.org/10.1007/s11932-003-0021-6

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  • DOI: https://doi.org/10.1007/s11932-003-0021-6

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