Changes in Water Soluble Uremic Toxins and Urinary Acute Kidney Injury Biomarkers After 10- and 100-km Runs

Abstract

Acute kidney injury (AKI) is described as a relatively common complication of exercise. In clinical practice the diagnosis of AKI is based on serum creatinine, the level of which is dependent not only on glomerular filtration rate but also on muscle mass and injury. Therefore, the diagnosis of AKI is overestimated after physical exercise. The aim of this study was to determine changes in uremic toxins: creatinine, urea, uric acid, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), trimethylamine N-oxide (TMAO) and urinary makers of AKI: albumin, neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 and cystatin-C (uCyst-C) after long runs. Sixteen runners, mean age 36.7 ± 8.2 years, (2 women, 14 men) participating in 10- and 100-km races were studied. Blood and urine were taken before and after the races to assess markers of AKI. A statistically significant increase in creatinine, urea, uric acid, SDMA and all studied urinary AKI markers was observed. TMAO and ADMA levels did not change. The changes in studied markers seem to be a physiological reaction, because they were observed almost in every runner. The diagnosis of kidney failure after exercise is challenging. The most valuable novel markers which can help in post-exercise AKI diagnosis are uCyst-C and uNGAL.

Changes in Novel AKI Biomarkers after Exercise. A Systematic Review

“…Bongers, who studied uNGAL after 30 and 150 min of exercise, found that uncorrected uNGAL and uNGAL corrected to osmolality were increased, while there were no changes in uNGAL corrected to creatinine and cystatin-C [26]. After a 10-km run, both uNGAL and uNGAL/Cr increased significantly (3.9-and 2.9-fold, respectively) in the Wołyniec study [45]. Otherwise, in Semen et al's study, a 10 km run caused an increase in uNGAL only when combined with ibuprofen/naproxen use [49].…”

“…There was a 2.56-fold increase after 10 km and a 4.96-fold increase after 100 km. When normalized to creatinine, these increases were 1.39-and 1.95-fold, respectively [45].…”

“…Bongers found that prolonged walking exercise at 70% intensity caused a 2.25-fold increase in uNGAL on day 1, and a 1.54-fold increase on day 3 compared to the baseline levels [44]. An uNGAL increase was also found by Lippi et al after a 60-km run (7.7-fold increase in uNGAL) [40], by Jouffroy et al after an 80-km run (5-fold increase after 53 km, and 2.5-fold after 80 km, without significant changes in uNGAL/uCr) [51], by Wolyniec et al after 100 km (6.82-fold increase in uNGAL, and only a 2.94-fold increase in uNGAL/uCr) [45] and by Poussel el al. after a 120-km run (2.6-fold increase in uNGAL and a 1.5-fold in uNGAL/uCr) [27].…”

“…This difference could be partially explained by the higher intensity of a 10-km run but could also be related to the methodology. In the first study, urine samples were collected immediately after the run and in the second, urine samples were collected within 2 h after the run [45,50].…”

Effects of Exercise on Biomarkers in Health and Disease: Some New Insights with Special Focus on Extreme Exercise and Healthy Ageing

“…Acute kidney injury (AKI) is described as a relatively common complication of exercise, namely prolonged runs. Wolyniec et al [2] found that typical urinary AKI markers were elevated after both 10 and 100 km runs, and concluded that there seems to be a physiological reaction rather than proof of kidney injury. However, their results support the use of neutrophil gelatinase-associated lipocalin and cystatin-C as the most valuable novel markers which can help in post-exercise AKI diagnosis.…”