Medline ® Abstracts for References 1,4,5
of 'Exercise-induced hematuria'
Sport-related hematuria: a review.
Jones GR, Newhouse I
Clin J Sport Med. 1997;7(2):119.
OBJECTIVE: To present an overview and models of the potential causes and implications of sport-related hematuria in an athletic population as provided by a literature review.
DATA SOURCES: A total of 64 published scientific articles have been utilized to provide a review of sport-related hematuria.
STUDY SELECTION: Reviewed studies were selected on the basis that they provided informative findings about the possible mechanisms of sport-related hematuria attributed to exercise duration and intensity. These studies used both normal adult and athletic populations.
DATA EXTRACTION: A review of the literature on the potential mechanisms of sport-related hematuria led to the classification of these mechanisms as either exercise duration related or exercise intensity related.
DATA SYNTHESIS: Research has revealed an increased prevalence of hematuria in athletes. The mechanisms responsible may be traced to different sources or a combination thereof. Many explanations have been directed toward a potentialcause; foot-strike hemolysis, renal ischemia, hypoxic damage to the kidney, the release of a hemolyzing factor, bladder and/or kidney trauma, nonsteroidal anti-inflammatory drugs, dehydration, increased circulation rate, myoglobinuria release, and the peroxidation of red blood cells. These mechanisms are presented in two models depicting the influence of either exercise intensity or exercise duration on sport-related hematuria.
CONCLUSIONS: Athletes, coaches, and sports medicine professionals should be aware of this condition because frequent high-intensity and/or long-duration workouts and competitions may promote the symptoms. Repeated red blood cell loss through the urine may be a contributing factor toward promoting anemic conditions in competitive athletes. Recognition of the potential mechanisms can spare the time and expense of invasive testing.
University of Western Ontario, London, Canada.
Gambrell RC, Blount BW
Am Fam Physician. 1996;53(3):905.
Bloody or discolored urine after exercise can have various etiologies. Exercise-induced hematuria is a common, benign cause of discolored urine following strenuous exercise. Evaluation of patients with this complaint begins with a thorough history, a focused physical examination and a microscopic examination of the urine. Using a systematic approach, the physician can detect serious, treatable problems, and testing can be limited. Patients with exercise-induced hematuria can be reassured that the condition is benign and that they can return to full activity.
Medical College of Georgia, Augusta, Georgia, USA.
Abarbanel J, Benet AE, Lask D, Kimche D
J Urol. 1990;143(5):887.
Strenuous exercise makes extraordinary demands. The transition from rest to intensive physical activity can cause pathological changes in various organs, particularly in the urinary tract. Hematuria (microscopic or macroscopic) is one of the abnormalities commonly found after sports activity. This phenomenon can occur in noncontact sports (such as rowing, running and swimming) as well as in contact sports (boxing, football and so forth). The pathophysiology can be either traumatic or nontraumatic. Renal trauma and/or bladder injury due to repeated impact of the posterior bladder wall against the bladder base can cause vascular lesions and consequently hematuria. There are 2 mechanisms of nontraumatic injury. 1) Vasoconstriction of the splanchnic and renal vessels occurs during exercise in order that blood can be redistributed to the contracting skeletal muscles, thus causing hypoxic damage to the nephron. This results in increased glomerular permeability which would favor increased excretion of erythrocytes and protein into the urine. 2) A relatively more marked constriction of the efferent glomerular arterioli results in an increased filtration pressure, which favors increased excretion of protein and red blood cells into the urine. 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.
Department of Urology, Golda Medical Center, Hasharon Hospital, Petah Tiqva, Israel.