- Angelo Mercieri, MD
Angelo Mercieri, MD
- Internal Medicine Unit
- Head Physician of Emergencies Unit
- Bolognini Hospital, Seriate, Bergamo, Italy
Exercise is the one of the many causes of hematuria (increased red blood cells excretion in the urine) (figure 1). Exercise-induced hematuria can be defined as gross or microscopic hematuria that occurs after strenuous exercise and resolves with rest in individuals with no apparent underlying kidney or urinary tract pathology .
Issues related to exercise-induced hematuria in otherwise healthy individuals will be reviewed here. Exercise may also worsen hematuria in patients with underlying glomerular disease, such as IgA nephropathy [2,3].
The general evaluation of adults or children with hematuria is discussed separately. (See "Etiology and evaluation of hematuria in adults" and "Evaluation of microscopic hematuria in children" and "Evaluation of gross hematuria in children".)
ETIOLOGY AND PATHOGENESIS
Hematuria has been described after a variety of forms of exercise [1,4,5]. These include contact sports, such as football and boxing, and noncontact sports, such as long-distance (marathon or endurance) running [6-8], rowing, and swimming. Hematuria appears to be rare with cycling but has been described, even with stationary bike riding (eg, spinning) [9,10].
The frequency with which hematuria occurs with long-distance running was evaluated in a study of 45 male and female participants who competed in an ultra long-distance marathon . After the race, 11 (24 percent) had hematuria. The hematuria disappeared within seven days. A similar incidence (18 percent) was noted in a report of 50 marathon runners who did not have hematuria on prerace samples obtained daily for three days .
- Jones GR, Newhouse I. Sport-related hematuria: a review. Clin J Sport Med 1997; 7:119.
- Colasanti G, Banfi G, di Belgiojoso GB, et al. Idiopathic IgA mesangial nephropathy: clinical features. Contrib Nephrol 1984; 40:147.
- Tomino Y, Sakai H. Exacerbating factors in patients with IgA nephropathy. Semin Nephrol 1987; 7:315.
- Gambrell RC, Blount BW. Exercised-induced hematuria. Am Fam Physician 1996; 53:905.
- Abarbanel J, Benet AE, Lask D, Kimche D. Sports hematuria. J Urol 1990; 143:887.
- Kallmeyer JC, Miller NM. Urinary changes in ultra long-distance marathon runners. Nephron 1993; 64:119.
- Blacklock NJ. Bladder trauma in the long-distance runner: "10,000 metres haematuria". Br J Urol 1977; 49:129.
- Fassett RG, Owen JE, Fairley J, et al. Urinary red-cell morphology during exercise. Br Med J (Clin Res Ed) 1982; 285:1455.
- Albersen M, Mortelmans LJ, Baert JA. Mountainbiker's hematuria: a case report. Eur J Emerg Med 2006; 13:236.
- Algazy KM. Spinner's hematuria. N Engl J Med 2002; 346:1676.
- Siegel AJ, Hennekens CH, Solomon HS, Van Boeckel B. Exercise-related hematuria. Findings in a group of marathon runners. JAMA 1979; 241:391.
- Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol 2005; 47:277.
- LaSalle M, Salimpour P, Adelstein M, et al. Sexual and urinary tract dysfunction in female bicyclists. J Urol 1999; 161:269.
- Nichols TW Jr. Bicycle-seat hematuria. N Engl J Med 1984; 311:1128.
- Salcedo JR. Huffy-bike hematuria. N Engl J Med 1986; 315:768.
- Fairley KF, Birch DF. Hematuria: a simple method for identifying glomerular bleeding. Kidney Int 1982; 21:105.
- Kincaid-Smith P. Haematuria and exercise-related haematuria. Br Med J (Clin Res Ed) 1982; 285:1595.
- Bellinghieri G, Savica V, Santoro D. Renal alterations during exercise. J Ren Nutr 2008; 18:158.
- Mercieri A, Mercieri M, Armanini M, Raiteri M. Exertional haematuria. Lancet 2002; 359:1402.
- Hanna HE, Santella RN, Zawada ET Jr, Masterson TE. Nutcracker syndrome: an underdiagnosed cause for hematuria? S D J Med 1997; 50:429.
- Zhang H, Li M, Jin W, et al. The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg 2007; 21:198.
- Shokeir AA, el-Diasty TA, Ghoneim MA. The nutcracker syndrome: new methods of diagnosis and treatment. Br J Urol 1994; 74:139.
- Mueller EJ, Thompson IM. Bladder carcinoma presenting as exercise-induced hematuria. Postgrad Med 1988; 84:173.
- Oosterom DL, Betjes MG. [Exertion-related abnormalities in the urine]. Ned Tijdschr Geneeskd 2006; 150:606.
- Yusof A, Leithauser RM, Roth HJ, et al. Exercise-induced hemolysis is caused by protein modification and most evident during the early phase of an ultraendurance race. J Appl Physiol (1985) 2007; 102:582.