Abstract
There are two types of acute renal failure induced by exercise. One is due to myoglobin and occurs after a marathon or other such prolonged exercise (exertional rhabdomyolysis), and the other type is not related to myoglobin and occurs after a dash or other anaerobic exercise (exercise-induced acute renal failure : ALPE). Typically, a young male takes 200meter dash at an athletic meeting and then complains of severe loin pain, nausea and vomiting after several hours,and comes to an emergency clinic at night. This type of acute renal failure is called as ALPE. Exercise-induced acute renal failure is ALPE, not exertional rhabdomyolysis with acute renal failure. Renal hypouricemia is the most important risk factor for this exercise-induced acute renal failure (ALPE). The serum CK value is within the normal limits, or less than 9 times normal. In a survey of 221 ALPE cases, the median serum creatinine at the time of consultation was 4.0 mg/dl, the median maximal value of serum creatinine was 5.6 mg/dl and most patients recover conservatively, however, hemodialysis was required in 23% of cases. Fifty-eight percent of reported cases show renal hypouricemia (23% of our series). Renal ischemia, which is demonstrated by patchy wedge-shaped contrast enhancement on delayed CT, is related to the etiology and loin pain. Renal ischemia due to unknown metabolic substance released from muscle during anaerobic exercise is proposed as the pathogenesis of ALPE without ample evidence. Hypotheses on the high risk for ALPE in patients with renal hypouricemia, are acute uric acid nephropathy, poor scavenging activity of reactive oxygen and abnormality of the urate transporter.
