Exercise-Induced Acute Kidney Injury in a Police Officer with Hereditary Renal Hypouricemia

Abstract

Hereditary renal hypouricemia is characterized by hypouricemia with hyper-uric acid clearance due to a defect in renal tubular transport. Patients with hereditary renal hypouricemia have a higher risk of exercise-induced acute kidney injury (EAKI) and reduced kidney function. Although the best preventive measure is avoiding exercise, there are many kinds of jobs that require occupational exercise. A 27-year-old male police officer suffered from stage 3 AKI after performing a 20-m multistage shuttle run test. His mother had previously been diagnosed as having renal hypouricemia at another facility. The patient had reported having hypouricemia during a health check at a previous police station, but his serum uric acid concentration was within the normal range at our hospital. After treatment, he recovered from EAKI and exhibited low serum uric acid and hyper-uric acid clearance. Since the patient desired to continue his career requiring strenuous exercise, it was difficult to establish a preventive plan against the recurrence of EAKI. Patients with hereditary renal hypouricemia who must undergo strenuous occupational anaerobic exercise are at higher risk of developing EAKI than other workers. The risks of EAKI among patients with hypouricemia should be considered when undergoing physical occupational training.

Recurrent Acute Kidney Injury with Severe Loin Pain and Patchy Renal Ischaemia after Anaerobic Exercise without Renal Hypouricaemia in a New Zealand European Male

“…Similar employment challenges may present for other professional athletes and occupations that require intense exercise. There have been cases in Japan of work-related ALPE in a police officer and a professional cyclist, although they continued their careers despite the ongoing risk of recurrence [ 15 ]. Whilst prohibiting intense anaerobic exercise is an effective strategy to prevent ALPE recurrence, this can have significant social, economic, and psychological implications for patients.…”

A Case of Idiopathic Renal Hypouricemia with SLC22A12 Gene Mutation Showing General Weakness and Incidental Renal Stone

“…Additional evaluation of his family members could have made the trait and herit ability of the disease more clear. Low level of uric acid, an effective antioxidant acting as a vasodilator, and anaerobic exercises triggering vasocon striction have a negative synergistic effect on glomerular filtration rate 11) . Thus, sudden onset of AKI can occur a few hours or days after strenuous physical exercises and within the same context, episodes of acute gastroenteritis may cause AKI in patients with renal hypouricemia.…”

Mutation in the SLC2A9 Gene: A New Family with Familial Renal Hypouricemia Type 2

“…RHUC is a rare autosomal recessive genetic disease caused by impaired renal tubular urate transport [1][2][3][4][5][6][7][8][9][10]. Less common than type 1 caused by mutations in the SLC22A12 gene encoding the major uric acid transporter URAT1 (OMIM #220150), type 2 (RHUC2, OMIM #612076) is caused by mutations in the SLC2A9 gene which encodes GLUT9 [1][2][3][4][5][7][8][9][10].…”

“…Unlike hyperuricemia and gout, hypouricemia has been thought as a disorder with no clinical significance. However, individuals with RHUC may present with exercise-induced acute kidney injury and nephrolithiasis [1][2][3][4][5][6][7][8][9][10]. Here, we report the case of a patient who developed acute kidney injury after strenuous exercise.…”