Summary of 11 case reports of 27 athletes with AKI following a marathon or ultramarathon
| Study | Cases | Collapse | Delayed* | Type | NSAIDs | Dialysis | Risk factors | SCr (µmol/L) | CK (U/L) | Urine | Follow-up | Biopsy | Diagnosis / comments |
| Dancaster, 196930 | 2 | 2 | 2 | Ultramarathon | Both took an analgesic | – | Diarrhoea (2) Vomiting (1) | – | – | Case 1: moderate albumin; Case 2: 2+ protein, RBCs and granular casts; spectral exam -ve for blood and myoglobin; occult test for blood +ve | Case 1: 1 year CrCl 115 mL/min | Rhabdomyolysis. Case 2 had markedly elevated AST, ALT, LDH | |
| Pollard 197040 | 1 | 1 | Marathon | - | Reported recurrent haematuria postexercise | 1193 72 hours post | 3+ RBCs, granular casts; spectroscopy –ve for free haemoglobin and myoglobin | Renal function ‘normal’ at 4/52 | ATN | March Haemoglobinuria? Bilateral flank pain | |||
| MacSearraigh, 197945 | 8 | 3 | 3 | Ultramarathon | 5 | 5 | Diarrhoea (1), Vomiting (3), EHS (1), recent illness (3) Hypertension (2) | – | Case 4: 28 000 | Case 3: 6 years normal CrCl. 4: normal 15/12 7: CrCl normal 9: ‘normal’ | Case 4 ATN Case 8: ATN and old fibrosis | n=7: severe muscle cramps, dark urine | |
| Bar-Sela, 197941 | 1 | 1 | Marathon | 1 | Recent flu-like illness | 751 | 10 400 | Proteinuria, RBCs, granular casts; -ve for myoglobin | normal CrCl 6/12 | Rhabdomyolysis: severe muscle cramps in race, dark urine | |||
| Goldsmith, 198442 | 1 | 1 | Marathon | 1 | – | 253 1/52 post | - | Weakly +ve for RBCs | Full recovery 6/52 | Rhabdomyolysis (presumed)—stiff leg muscles, lumbar pain to groins, polydipsia | |||
| Vitting,198633 | 1 | 1 | Marathon | 1 | 1 | Hypertension | 1025 48 hours | 83 | 3+ protein, 1+ RBC, scattered renal tubular cells, few erythrocytes | Day 26 SCr 106 | |||
| Seedat,198931 | 4 | 1 | 3 | Ultramarathon | 4 | 3 | Recent UTI Influenza | Case 1: 930 2: 604 3: 593 4: 1263 | 1: 39 800 2: 29 800 3: 24 120 4: 2220 | Not reported | |||
| Le Meurl, 199843 | 1 | 1 | Marathon | 1 | Recurrent haematuria on exercise; frank haematuria in race | 1,070 48 hours post | 233 | RBC count 4×106/mL; haemoglobinuria slightly +ve; myoglobinuria -ve | Full recovery 2/12 | ATN | Authors speculated haematuria of glomerular origin from prolonged exercise leading to intraluminal obstruction or toxic effect of haemoglobin on tubular cells similar to IgA nephropathy. | ||
| van Zyl-Smit, 200046 | 1 | 1 | Ultramarathon | – | 713, 10 days post | – | 2+ protein 1+ blood, moderate granular casts | full recovery | Rhabdomyolysis (presumed) | ||||
| Bruso,201044 | 3 | 3 | Ultramarathon | 3 | – | Case 1: vomiting, Case 1 and 3 required intravenous fluid post race | Case 1 911 Case 2 433 Case 3 283 | Case 1: 7 85 250 Case 2: 38 218 Case 3:>40 000 | Case 1: 3+ blood, 1+ protein Case 2: 3+ blood, trace protein Case 3: 1+ blood | All rhabdomyolysis Case 1: 12 days in hospital; 2: 3 days in hospital 3: 1 day in hospital 2 presented<24 hours; 1 presented 48 hours; all hyponatraemic (range 129–134) | |||
| Boulter,201147 | 4 | 4 | Ultramarathon | 4 | 4 | All taken supplement; Vomiting (3) | Case 1: 656 2: 264 3: 551 4: 1139 | Case 1: 48 934 2: N/A 3: 54 231 4: 5718 | Rhabdomyolysis (4)—cases presented 1–4 days postrace. | ||||
| Total | 27 | 8 | 21 | 18 | 15 | 4 |
AKI, acute kidney injury; ATN, acute tubular necrosis; CK, creatine kinase; CrCl, creatinine clearance; EHS, exertional heat stroke; RBCs, red blood cells, SCr, serum creatinine; *delayed presentation to medical services.