A Case of March Hemoglobinuria Induced by Kendo Exercise with Iron Deposition in Proximal Tubular Cells

Nishioka, Rika; Sofue, Tadashi; Onishi, Keisuke; Fujita, Takeshi; Ozaki, Taro; Moritoki, Masahiro; Nishijima, Yoko; Imataki, Osamu; Kushida, Yoshio; Minamino, Tetsuo

doi:10.2169/naika.106.1191

Cited by 1 publication

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“…Previous report also indicated no tubular dysfunction [ 11 ]. Thus, there are very few case reports of renal biopsy for march hemoglobinuria [ 11 – 13 ]. In the present case, hemosiderin deposition was observed in the proximal tubule, and iron granules were also taken up in lysosomes, as observed in electron microscopic findings, which led to a definitive diagnosis of march hemoglobinuria.…”

Section: Discussionmentioning

confidence: 75%

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March hemoglobinuria progressed to acute kidney injury after kendo practice: a case report

et al. 2022

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Background March hemoglobinuria is caused by a hemolytic mechanism due to transient hematuria after physical exercise which, although rare, may lead to acute kidney injury. We report a case of a patient with march hemoglobinuria induced by kendo, which was diagnosed by the presence of Berlin blue iron staining in the proximal tubules through renal biopsy. Case presentation A 15-year-old male complained of fever (37 °C), general malaise, and nausea after hard kendo sessions. Laboratory findings revealed indirect bilirubin dominant hyperbilirubinemia (total bilirubin 3.8 mg/dL), high lactate dehydrogenase (LDH), and acute kidney injury (serum creatinine: 3.11 mg/dL and estimated glomerular filtration rate: 26 mL/min/1.73m2). Urine test was positive for occult blood but without hematuria. Renal biopsy was performed to clarify the cause of renal injury, which showed minor glomerular abnormalities. Meanwhile, hemosiderin deposition was identified in the proximal tubules by Berlin blue iron staining, and lysosomes were observed to contain granular iron. In addition to clinical background of strenuous kendo exercise, renal biopsy led to a definitive diagnosis of march hemoglobinuria. Conclusions March hemoglobinuria is a hemolytic disease that can occur after intense exercise, especially kendo. Considering its rarity due to the lack of critical symptoms, it is important to note that occult blood-positive findings may be indicative of march hemoglobinuria if the patient underwent strenuous exercise. Therefore, clinicians should be aware of this possibility to provide timely and appropriate treatment.

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Section: Discussionmentioning

confidence: 75%

“…There were no abnormalities in urinary levels of NAG, β2MG, α1MG and L-FABP in present case (Table 1). Previous report also indicated no tubular dysfunction [11]. Thus, there are very few case reports of renal biopsy for march hemoglobinuria [11][12][13].…”

Section: Discussionmentioning

confidence: 91%