Sports Hematuria

Abstract

Strenuous exercise makes extraordinary demands. The transition from rest to intensive physical activity can cause pathological changes in various organs, particularly in the urinary tract. Hematuria (microscopic or macroscopic) is one of the abnormalities commonly found after sports activity. This phenomenon can occur in noncontact sports (such as rowing, running and swimming) as well as in contact sports (boxing, football and so forth). The pathophysiology can be either traumatic or nontraumatic. Renal trauma and/or bladder injury due to repeated impact of the posterior bladder wall against the bladder base can cause vascular lesions and consequently hematuria. There are 2 mechanisms of nontraumatic injury. 1) Vasoconstriction of the splanchnic and renal vessels occurs during exercise in order that blood can be redistributed to the contracting skeletal muscles, thus causing hypoxic damage to the nephron. This results in increased glomerular permeability which would favor increased excretion of erythrocytes and protein into the urine. 2) A relatively more marked constriction of the efferent glomerular arterioli results in an increased filtration pressure, which favors increased excretion of protein and red blood cells into the urine. It must be noted that sports hematuria differs from other conditions that may cause reddish discoloration of the urine due to physical exercise, such as march hemoglobinuria and exercise myoglobinuria. In the latter 2 abnormalities there is excretion of hemoglobin and myoglobin molecules in the urine and not whole blood or intact red blood cells. Sports hematuria usually has a benign self-limited course. However, coexisting urinary tract pathological conditions should be excluded carefully.

The effect of exercise intensity on hematuria in healthy male runners

“…The reduction in renal blood¯ow that occurs during exercise is caused by vasoconstriction, and it will result in an ischemic condition as well as altered kidney function (Abarbanel et al 1990;Javitt and Miller 1952;Poortmans et al 1990). The mechanism controlling renal arteriolar vasoconstriction is alpha-adrenergic neural stimulation; which causes the secretion of circulating norepinephrine (Guyton 1991).…”

“…Dysmorphic RBCs may occur in urine when abnormal glomerular permeability allows RBCs to pass through the nephrons in the kidney (Poortmans and Henrist 1989). Their presence implicates altered function of the kidney (Abarbanel et al 1990;Poortmans et al 1981). In addition, urinary RBC casts, particularly the hyaline type which originate at the renal cortex, provide evidence of glomerular origin (Schneider et al 1992).…”

Post exertional hematuria

“…The incidence of 12% hematuria after the run seen in our study is more in tandem with that found in Israeli Air Force recruits (5%), 1 unlike the incidence of470% seen in hard core athletes like ultra marathoners, 3 long distance skiers or 45% in professional athletes. [9][10][11][12][13][14] All investigators have commented that post exertional hematuria subsides within 72 h. [2][3][4]12,16,18 However, 19% of our subjects had persistence of hematuria beyond 72 h, and three individuals continued to have hematuria beyond 14 days. On evaluation, they were found to have primary glomerular disease.…”

“…Fassett et al based on presence of dysmorphic RBC suggested its origin to the glomerulus, 8 while others have suggested foot strike induced trauma and resultant hemolysis as the underlying pathology. [9][10][11] Some workers have suggested acidosis and hypoxia-related glomerular injury as the cause [12][13][14][15] ; however, recent data suggest it to be originating from lower tract. [12][13][14][15] McInnis et al 16 observed that post exertional hematuria is greater after intense weight bearing exercise rather than long duration non weight bearing exercise like cycling.…”

“…[9][10][11] Some workers have suggested acidosis and hypoxia-related glomerular injury as the cause [12][13][14][15] ; however, recent data suggest it to be originating from lower tract. [12][13][14][15] McInnis et al 16 observed that post exertional hematuria is greater after intense weight bearing exercise rather than long duration non weight bearing exercise like cycling. Falsetti et al, 9 Poortmans and Jeanloz 13 and Helzer et al 17 observed that the intensity of exercise correlated with urinary abnormalities.…”