Why does running cause hematuria

A search using Google Scholar was also conducted, and two studies were selected. One study was found through a general Internet search. Duplicate studies were then discarded from our source data pool. Studies included case reports, nonrandomized control trials, quasi-experimental studies, and systematic reviews.

A Cochrane review was completed without a subject review on the topic. Most included studies were from Many organizations recommend no screening for asymptomatic microscopic hematuria, so investigations can be done if researchers intentionally are searching for exercise microscopic hematuria 1. Patients with persistent hematuria of longer than 48 hours should undergo cystoscopy of the urinary bladder, and gross or microscopic cytological evaluation of exfoliated cells in the urine sample 1.

A repeat urinalysis should occur two days after activity if the cause behind hematuria is thought to be physiological in nature due to menstruation, sexual activity, strenuous exercise, and trauma 1. Performance, distance, and intensity are relevant to endurance and the development of acute renal injuries. In a study of 25 male kilometer km ultra-endurance runners, 17 tested positive for hematuria post-race 3.

When the runners were re-checked 24 hours post-event, six tested positive for hematuria 3. Prolonged activity modifies hematological parameters and promotes anemia, leading to decreases in hemoglobin and hematocrit levels 3. Oxidative stress responses, hemolysis, and gastrointestinal bleeding were thought to contribute to the development of hematuria 3. The presence of hematuria can be a benign clinical problem, or a malignant process, that may indicate altered function of the kidney 5.

However, hematuria is one of the most common urine abnormalities found after physical activity 5. Countermovement jumping on a force platform performed post-race, and increased exercise intensity is thought to have been a contributing factor to urological changes, in addition to muscle fatigue and muscle breakdown 5. These variables suggest rapid changes in body mass due to prolonged exercise could be a contributing factor to the development of hematuria.

The diagnostic approach to microscopic hematuria is to rule out renal injury and urethral, ureteral, bladder, or renal malignancy 8. The American Urological Association recommends computed tomography CT scans, urography and cystoscopy as interventions 7.

Risks of these tests include infection, radiation exposure, and contrast-induced nephropathy 7. In , the diagnosis of hematuria was associated with 2. While no major organization supports routine genitourinary cancer screening, routine urinalysis can detect hematuria 7.

The combination of ultrasound and cystoscopy are cost-effective strategies for diagnosing, or ruling out malignancy 7. Iron is a critical mineral that helps optimize athletic performance due to the role it plays in energy metabolism, oxygen transports, and balancing acid-base levels 8. Common reasons for elevated urinary blood losses are damage to the kidney because of hypoxia, increased renal blood pressure, increased body temperature, exercise-associated acidosis, renal or bladder trauma, and dehydration 8.

Increasing iron intake through diet modification or supplementation can decrease the risk of exercise-induced inflammation due to changes in hepcidin levels 8. Another study found that, among 26 subjects who participated in a km ultra-marathon, three subjects were observed to have hematuria immediately after the race 9. Plasma levels of potassium ions, sodium, creatinine, creatine kinase, renin, and aldosterone were significantly elevated immediately after the race, and were then significantly reduced one day after the race 9.

The development of hematuria in this situation, in addition to the rapid changes in lab values, demonstrates acute kidney injury due to prolonged exercise 9. Pretesting is an important variable to consider when evaluating hematuria or urological changes in addition to testing after the event. Another study involved 38 adolescent soccer players, in which 25 were found to have hematuria after the match These athletes had a urinalysis and blood pressure screening before the start to the soccer season Urinary proteins, osmolality, and cytology were also examined before and after matches used for evaluation Transient hematuria can be considered benign after intense physical activity; however, there is still a need to establish underlying causes and understand reasons for progression to chronic renal damage The loss of red blood cells following exercise can be up to two to three percent of the total red blood cell count, and the body quickly compensates within two to three days Hematuria can also develop due to sports-related blunt trauma High-grade renal injuries can develop from a solitary blow to the flank Hematuria could be detected through urinalysis or visualization.

CT scanning is the imaging modality of choice to evaluate and grade renal injuries due to trauma While these types of injuries might be isolated, they can occur during a prolonged sports event that falls under the category of an endurance activity. It is important to define what an endurance athlete is or could be.

Physical endurance is tied to activities involving conditioning, execution, skill, and technique. Endurance can be conceptualized as the ability to withstand hardship, adversity, or stress.

Athletes are trained or skilled in exercises, sports, or games requiring physical strength, agility, or stamina. For the purposes of this review, endurance athletes will be defined as persons who participate in a wide range of sports and activities that could include marathon running, sprinting, soccer, swimming, basketball, hockey, football, gymnastics, wrestling, mountain climbing, or tennis.

Microscopic hematuria is a problem in endurance athletes that often creates a dilemma for a provider. It is important to not dismiss the results, as malignancy is still a possibility for adults. Having the patient avoid physical activity, then complete another urinalysis in hours is suggested if hematuria is thought to be from exercise. If the urinalysis is negative for hematuria, it can be categorized as benign hematuria; if positive the sample should be tested under microscopic examination to confirm or refute the results 4.

In instances of a positive microscopic sample, the patient should then be referred to a nephrologist or urologist for further evaluation. The exact mechanism of injury of microscopic hematuria is unknown, but often reverses with cessation of insulting action. It is imperative that the provider consider exercise-induced hematuria in a patient who reports large amounts of physical activity, as repeat testing will hopefully avoid further advanced testing and expert consultation.

If the hematuria is related to direct trauma, then pain at the site of impact is expected. Sports Medicine Evaluation The sports medicine physician will perform a thorough history and physical exam of the athlete, often focusing on the genitourinary and gastrointestinal systems of the patient. Evaluation of a urine sample is needed to investigate hematuria. This will be done with both a urinalysis which looks for abnormal urine contents and with a microscope, for a more detailed look at the urine.

Further investigation may be needed depending on the results of these tests. Athletes may require repeat urinalysis testing until their hematuria has resolved. In cases where trauma is involved, imaging such as a computed tomography CT scan or ultrasound may be needed. Treatment In cases where there is no trauma, exercise-induced hematuria usually resolves within hours of rest after the athletic event. In these cases, no specific treatment is necessary.

If hematuria persists longer than 72 hours or continues to occur with strenuous exercise, further investigation may be needed. In cases where trauma is involved, treatment will depend on the severity of the trauma. Injury Prevention Recommendations for preventing hematuria include staying well hydrated and running with a bladder that is not completely empty.

In contact sports, wearing the proper protective equipment is necessary. 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.