WHAT DOES POST-EXERCISE PROTEINURIA TELL US ABOUT KIDNEYS?

• Authors: Wojciech Wołyniec , Wojciech Ratkowski , Katarzyna Zorena , Jacek Januszczyk , Karolina Kuźbicka , Robert Urbański , Patrycja Tkachenko-Rita , Marcin Renke , Dominik Rachoń
• Languages of publication: EN

Abstracts

EN

Objectives. Post exercise proteinuria (PEP) is found in about 20–40% of sportsmen after intensive exercise. Urinary NGAL is a new marker of tubulointerstitial kidney damage. The relationship between PEP and uNGAL has not been defined yet. In presented study a resting uNGAL as a predictor of PEP was analyzed. The changes of albuminuria after exercise were monitored to estimate a frequency and range of PEP. Methods. 40 amateur healthy runners (mean age 36.65 ±10.61 years) participating in 10-km run took part in the study. Before and after the competition urine was collected. NGAL, albumin and creatinine were subsequently measured in urine. uNGAL to creatinine ratio (NCR) and albumin to creatinine ratio (ACR) were calculated. Results. 28 participants (mean age 37.9 ±11.46, 19 M, 9 F) with uNGAL below 15 ng/ml before competition were analyzed. The increase of ACR was observed in every case. Mean post-exercise ACR was 104.55 ±123.1 mg/g and was significantly higher than pre-exercise ACR 6.33 ±5.86 mg/g (p < 0.0005). The positive correlation was found between resting NCR and post-exercise ACR (r = 0.60, p < 0.05). Conclusions. Resting uNGAL positively correlated with PEP. The possible explanation of these findings is that persons with PEP had some early, occult tubulointersitial kidney damage. It is speculated that those runners have higher risk of chronic kidney disease.

Keywords

EN

albuminuria; chronic kidney disease; health; running

Discipline

• MEDICINE: MEDICINE

• Journal: Central European Journal of Sport Sciences and Medicine
• Year: 2016
• Volume: 14
• Issue: 2
• Pages: 93 - 100

Contributors

author

Wojciech Wołyniec

• Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdansk, Poland,

author

Wojciech Ratkowski

• Academy of Physical Education and Sport, Gdansk, Poland

author

Katarzyna Zorena

• Department of Clinical and Experimental Endocrinology, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdańsk, Poland

author

Jacek Januszczyk

• Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdansk, Poland

author

Karolina Kuźbicka

• Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdansk, Poland

author

Robert Urbański

• Academy of Physical Education and Sport, Gdansk, Poland and

author

Patrycja Tkachenko-Rita

• Medical Laboratories Bruss Group ALAB, gdynia, Poland

author

Marcin Renke

• Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdansk, Poland

author

Dominik Rachoń

• Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Gdynia, Medical University of Gdansk, Poland

References

• Abdallah, E., Waked, E., Al-Helal, B., Asad, R., Nabil, M., Harba, T. (2013). Novel troponin-like biomarkers of acute kidney injury. Saudi J Kidney Dis Transp., 24, 1111–1124.
• Agarwal, R.P., Thanvi, I., Vachhani, G., Kochar, D.K., Rastogi, A. (1998). Exercise induced proteinuria as an early indicator of diabetic nephropathy. J Assoc Physicians India, 46, 772–774.
• Bello, A., Kawar, B., El Kossi, M., El Nahas, M. (2010). Epidemiology and pathophysiology of chronic kidney disease. In: Floege, J., Johnson, R.J., Feehally, J. (eds), Comprehensive Clinical Nephrology (pp. 907–918), Saunders, an imprint of Elsevier Inc. Printed in the United States of America.
• Curthoys, N.P., Moe, O.W. (2014). Proximal tubule function and response to acidosis. Clin J Am Soc Nephrol., 9, 1627–1638.
• Di Paolo, N., Garosi, G., Carrera, A., Monaci, G., Sansoni, E., Romolini, V., Gaggiotti, E., Nicolai, G.A. (2007). Evaluation of exercise testing for subjects with isolated proteinuria and/or hematuria of unclear significance. Eur J Intern Med, 18, 135–140.
• Hasegawa, M., Ishii, J., Kitagawa, F., Takahashi, K., Hayashi, H., Koide, S., Tomita, M., Takahashi, H., Ozaki, Y., Yuzawa, Y. (2015). Urinary neutrophil gelatinase-associated lipocalin as a predictor of cardiovascular events in patients with chronic kidney disease. Heart Vessels., 3, 81–88.
• Helmersson-Karlqvist, J., Larsson, A., Carlsson, A.C., Venge, P., Sundström, J., Ingelsson, E., Lind, L., Arnlov, J. (2013). Urinary neutrophil gelatinase-associated lipocalin (NGAL) is associated with mortality in a community-based cohort of older Swedish men. Atherosclerosis, 227, 408–413.
• Johnstone, D.B., Holzman, L.B. (2006). Clinical impact of research on the podocyte slit diaphragm. Nat Clin Pract Nephrol., 2, 271–282.
• Junglee, N.A., Di Felice, U., Dolci, A., Fortes, M.B., Jibani, M.M., Lemmey, A.B., Walsh, N.P., Macdonald, J.H. (2013). Exercising in a hot environment with muscle damage: effects on acute kidney injury biomarkers and kidney function. Am J Physiol Renal Physiol., 305, 813–820.
• Junglee, N.A., Lemmey, A.B., Burton, M., Searell, C., Jones, D., Lawley, J.S, Jibani, M.M., Macdonald, J.H. (2012). Does proteinuriainducing physical activity increase biomarkers of acute kidney injury? Kidney Blood Press Res., 36, 278–289.
• Kim, S.S., Song, S.H., Kim, I.J., Yang, J.Y., Lee, J.G., Kwak, I.S., Kim, Y.K. (2012). Clinical implication of urinary tubular markers in the early stage of nephropathy with type 2 diabetic patients. Diabetes Res Clin Pract., 97, 251–257.
• Lippi, G., Sanchis-Gomar, F., Salvagno, G.L., Aloe, R., Schena, F., Guidi, G.C. (2012). Variation of serum and urinary neutrophil gelatinase associated lipocalin (NGAL) after strenuous physical exercise. Clin Chem Lab Med, 50, 1585–1589.
• Mattix, H.J., Hsu, C.Y., Shaykevich, S., Curhan, G. (2002). Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race. J Am Soc Nephrol., 13, 1034–1039.
• McCullough, P.A., Chinnaiyan, K.M., Gallagher, M.J., Colar, J.M., Geddes, T., Gold, J.M., Trivax, J.E. (2011). Changes in renal markers and acute kidney injury after marathon running. Nephrology (Carlton), 16, 194–199.
• Miller, W.G., Bruns, D.E., Hortin, G.L., Sandberg, S., Aakre, K.M., McQueen, M.J., Itoh, Y., Seccombe, D.W., Jones, G., Bunk, D.M., Curhan, G.C., Narva, A.S. (2009). Current issues in measurement and reporting of urinary albumin excretion. Clin Chem., 55, 24–38.
• Poortmans, J.R. (1984). Exercise and renal function. Sports Med., 1, 125–153.
• Poortmans, J.R. (1985). Postexercise proteinuria in humans. Facts and mechanisms. JAMA., 253, 236.
• Poortmans, J.R., Blommaert, E., Baptista, M., De Broe, M.E., Nouwen, E.J. (1997). Evidence of differential renal dysfunctions during exercise in men. Eur J Appl Physiol Occup Physiol., 76, 88–91.
• Poortmans, J.R., Gulbis, B., De Bruyn, E., Baudry, S., Carpentier, A. (2013). Limitations of serum values to estimate glomerular filtration rate during exercise. Br J Sports Med., 47, 1166–1170.
• Russo, L.M., Sandoval, R.M., McKee, M., Osicka, T.M., Collins, A.B., Brown, D., Molitoris, B.A., Compar, W.D. (2007). The normal kidney filters nephrotic levels of albumin retrieved by proximal tubule cells: retrieval is disrupted in nephrotic states. Kidney Int., 71, 504–513.
• Singer, E., Markó, L., Paragas, N., Barasch, J., Dragun, D., Müller, D.N., Brudde, K., Schmidt-Ott, K.M. (2013). Neutrophil gelatinaseassociated lipocalin: pathophysiology and clinical applications. Acta Physiol (Oxf), 207, 663–672.
• Vanmassenhove, J., Vanholder, R., Nagler, E., Van Biesen, W. (2013). Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant., 28, 254–273.
• Viberti, G.C., Jarrett, R.J., McCartney, M., Keen, H. (1978). Increased glomerular permeability to albumin induced by exercise in diabetic subjects. Diabetologia., 14, 293–300.
• Wu, J., Ding, Y., Zhu, C., Shao, X., Xie, X., Lu, K., Wang, R. (2013). Urinary TNF-α and NGAL are correlated with the progression of nephropathy in patients with type 2 diabetes. Exp Ther Med., 6, 1482–1488.
• Zmysłowska, A., Młynarski, W., Wegner, O., Misiak, G., Szadkowska, A., Bodalski, J. (2007). Post-exercise microalbuminuria in newly diagnosed type 1 diabetic children – preliminary report. Med Wieku Rozwoj., 11, 139–143.

• Document Type: article