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exercise-induced hematuria
Etiology:
- direct trauma to the kidneys &/or bladder
- contact sports
- long-distance running, less common with bicycling
- exercise may exacerbate hematuria in patients with underlying glomerular disease such as IgA nephropathy
- Nutcracker syndrome
- compression of the left renal vein between the aorta & proximal superior mesenteric artery
Clinical manifestations:
- red to brown urine following exercise
Pathology:
- generally glomerulonephropathy
- renal ischemia due to shunting of blood to exercising muscles
- lactic acidosis, generated during anaerobic conditions, causes passage of erythrocytes into the urine, through increased glomerular permeability [2]
- proteinuria often accompanies the hematuria
- ecchymoses & frank contusions have been noted on cystoscopy after long-distance running, possibly due to repeated impact of the flaccid wall of the bladder against the bladder base
- a near empty bladder exacerbates the trauma
Laboratory:
- urinalysis
- gross hematuria or microscopic hematuria
Special laboratory:
- cystoscopy in patients > 50 years of age
Differential diagnosis:
- myoglobinuria due to rhabdomyolysis
- march hemoglobinuria
Management:
- generally a benign condition
General
hematuria
References
- Mercieri A
Exercise-induced hematuria
UpToDate
http://www.uptodate.com/contents/exercise-induced-hematuria
- Bellinghieri G, Savica V, Santoro D
Renal alterations during exercise
J Ren Nutr. 2008 Jan;18(1):158-64.
PMID: 18089464