Kidney Injury and Repair Biomarkers in Marathon Runners

Abstract

Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study Setting & Participants Runners participating in the 2015 Hartford Marathon Predictor Completing a marathon Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3 mg/dL increase in serum creatinine within 48 hours of day 0 and stage 2 was defined as a > 2- to 3-fold increase in creatinine. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours pre-marathon (Day 0), immediately post- marathon (Day 1) and 24 hours post-marathon (Day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed as well as urine microscopy analysis. Six injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and two repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41% were male. 82% of runners developed a rise in creatinine equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarkers peaked on Day 1 and were significantly elevated compared to Day 0 and Day 2. Serum creatine kinase levels continued to significantly rise from Day 0 to Day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediments diagnostic of tubular injury. Rise in injury and repair biomarkers suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

Impact of acuteversusprolonged exercise and dehydration on kidney function and injury

“…; Mansour et al. ). However, the postexercise uncorrected uNGAL level after prolonged exercise found in our study (16.5 ng/mL) was lower compared to previous studies with postexercise values ranging from 37.6 to 47.0 ng/mL (McCullough et al.…”

“…; Mansour et al. ). This might be explained by our relatively young population (23 years vs. >38 years), and the shorter period of exercise in our study (137 min vs. >240 min).…”

Impact of acute versus repetitive moderate intensity endurance exercise on kidney injury markers

“…; Mansour et al. ) increases urinary excretion of KIM1 (uKIM1) and NGAL (uNGAL). It has been suggested that exercise intensity is the most important factor that impacts on exercise‐induced kidney stress.…”

“…Over the past years, a number of new biomarkers have been identified to detect acute kidney injury in an early stage, of which Kidney Injury Molecule-1 (KIM1) and Neutrophil gelatinaseassociated lipocalin (NGAL) are best known (Mishra et al 2005;Bonventre 2008;Devarajan 2008). Previous studies suggested that a single bout of short-term high intensity exercise (Junglee et al 2012) or completing a (ultra)marathon (McCullough et al 2011;Lippi et al 2012;Mansour et al 2017) increases urinary excretion of KIM1 (uKIM1) and NGAL (uNGAL). It has been suggested that exercise intensity is the most important factor that impacts on exercise-induced kidney stress.…”

Exercício resistido intervalado de alta intensidade (HIIRT) causa danos musculares e renais em indivíduos saudáveis

“…O aumento rápido de TFF3 no presente estudo é provavelmente devido à lesão tubular proximal e distal induzida pelo HIIRT, e pode estar associado a início de processo regenerativo das células epiteliais. Um estudo prospectivo observacional em 22 corredores de maratona também encontrou aumento precoce nos biomarcadores de reparação tubular renal após exercício (glicoproteína 39 da cartilagem humana -YKL-40 e proteína 1 quimioatratora de monócitos -MCP-1) 24 .…”