Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

Lecina, Miguel; Otín, Carlos Castellar; López-Laval, Isaac; Páez, Luís Carrasco; Fuente, Francisco Pradas de la

doi:10.3390/medicina58050569

Cited by 3 publications

(1 citation statement)

References 87 publications

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“…1,2 A 2022 systematic review of 1113 ultrarunners over the last 15 y reported an overall incidence of mild AKI of 42%, with only 1 case (0.01%) meeting the criteria for severe renal failure but not requiring dialysis. 3 In addition, a systematic review of case reports identified only 27 runners who developed severe AKI following marathon or ultramarathon running. 2 Of the 27 runners, only 15 required dialysis.…”

Section: Introductionmentioning

confidence: 99%

Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners

Pasternak¹,

Newkirk-Thompson²,

Howard³

et al. 2023

Wilderness & Environmental Medicine

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Transient acute kidney injury (AKI) following ultraendurance footraces is a common biochemical diagnosis. However, severe AKI requiring renal replacement therapy is uncommon in ultramarathoners. We report 4 runners (3 men; mean age, 44 ± 3 y) who required prolonged (10-42 d) dialysis following the Western States 100 Mile Endurance Run over a 3-y span (0.38% of starters). The maximum ambient temperatures on the race day ranged from 36.6 • to 38.3 • C. The runners presented to local hospitals 17 to 32 h after running, with laboratories confirming rhabdomyolysis, hyponatremia (mean serum sodium concentration, 127±2 mmol⋅L -1 ), and AKI (mean serum creatinine concentration, 8.5±2 mg⋅dL -1 ). The case-cluster report highlights the potential synergistic effects of high ambient temperatures, muscle damage, and electrolyte imbalance on protracted renal dysfunction in ultramarathoners competing in a warming world.

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Section: Introductionmentioning

confidence: 99%

Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners

Pasternak¹,

Newkirk-Thompson²,

Howard³

et al. 2023

Wilderness & Environmental Medicine

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Physical exercise as a friend not a foe in acute kidney diseases through immune system modulation

Costanti-Nascimento,

Brelaz-Abreu,

Bragança-Jardim

et al. 2023

Front. Immunol.

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Regular and moderate exercise is being used for therapeutic purposes in treating several diseases, including cancer, cardiovascular diseases, arthritis, and even chronic kidney diseases (CKDs). Conversely, extenuating physical exercise has long been pointed out as one of the sources of acute kidney injury (AKI) due to its severe impact on the body’s physiology. AKI development is associated with increased tubular necrosis, which initiates a cascade of inflammatory responses. The latter involves cytokine production, immune cell (macrophages, lymphocytes, and neutrophils, among others) activation, and increased oxidative stress. AKI can induce prolonged fibrosis stimulation, leading to CKD development. The need for therapeutic alternative treatments for AKI is still a relevant issue. In this context arises the question as to whether moderate, not extenuating, exercise could, on some level, prevent AKI. Several studies have shown that moderate exercise can help reduce tissue damage and increase the functional recovery of the kidneys after an acute injury. In particular, the immune system can be modulated by exercise, leading to a better recovery from different pathologies. In this review, we aimed to explore the role of exercise not as a trigger of AKI, but as a modulator of the inflammatory/immune system in the prevention or recovery from AKI in different scenarios. In AKI induced by ischemia and reperfusion, sepsis, diabetes, antibiotics, or chemotherapy, regular and/or moderate exercise could modulate the immune system toward a more regulatory immune response, presenting, in general, an anti-inflammatory profile. Exercise was shown to diminish oxidative stress, inflammatory markers (caspase-3, lactate dehydrogenase, and nitric oxide), inflammatory cytokines (interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-α (TNF-α)), modulate lymphocytes to an immune suppressive phenotype, and decrease tumor necrosis factor-β (TGF-β), a cytokine associated with fibrosis development. Thus, it creates an AKI recovery environment with less tissue damage, hypoxia, apoptosis, or fibrosis. In conclusion, the practice of regular moderate physical exercise has an impact on the immune system, favoring a regulatory and anti-inflammatory profile that prevents the occurrence of AKI and/or assists in the recovery from AKI. Moderate exercise should be considered for patients with AKI as a complementary therapy.

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Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment

Gilloteaux,

De Swert,

Suain

et al. 2023

IJMS

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A murine osmotic demyelinating syndrome (ODS) model was developed through chronic hyponatremia, induced by desmopressin subcutaneous implants, followed by precipitous sodium restoration. The thalamic ventral posterolateral (VPL) and ventral posteromedial (VPM) relay nuclei were the most demyelinated regions where neuroglial damage could be evidenced without immune response. This report showed that following chronic hyponatremia, 12 h and 48 h time lapses after rebalancing osmolarity, amid the ODS-degraded outskirts, some resilient neuronal cell bodies built up primary cilium and axon hillock regions that extended into axon initial segments (AIS) where ADP-ribosylation factor-like protein 13B (ARL13B)-immunolabeled rod-like shape content was revealed. These AIS-labeled shaft lengths appeared proportional with the distance of neuronal cell bodies away from the ODS damaged epicenter and time lapses after correction of hyponatremia. Fine structure examination verified these neuron abundant transcriptions and translation regions marked by the ARL13B labeling associated with cell neurotubules and their complex cytoskeletal macromolecular architecture. This necessitated energetic transport to organize and restore those AIS away from the damaged ODS core demyelinated zone in the murine model. These labeled structures could substantiate how thalamic neuron resilience occurred as possible steps of a healing course out of ODS.

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Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review

Cited by 3 publications

References 87 publications

Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners

Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners

Physical exercise as a friend not a foe in acute kidney diseases through immune system modulation

Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment

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