Nephrol Dial Transplant (1999) 14: 2030-2031
© 1999 European Renal Association-European Dialysis and Transplant Association
The Interesting Case
Exercise induced macroscopic haematuria: run for a diagnosis?
Department of Internal Medicine, University Hospital, Groningen, The Netherlands
Correspondence and offprint requests to: Froukje L. Ubels, MD, Department of Internal Medicine, University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Keywords: macroscopic haematuria; exercise; running
Case report
A 42-year-old Caucasian female consulted our outpatient clinic because of exercise-related macroscopic haematuria. She has always been in excellent health, with different examinations during several years of her sporting career. A few months before, after return from a training camp in Denmark, she developed myalgia in the upper legs and frequently yellowish thin stool. After treatment with metronidazole, given because intestinal amebiasis was diagnosed in two participants of the same training camp, these complaints disappeared.
A few weeks later, reddish-coloured urine was observed after running, which she thought to be the result of menstruation, but tampons remained clean. Since that time, she consequently produced bright red-coloured urine after running, regardless of running distance or intensity. Every time, the urine returned to appear normal two or three voidings later. There was no dysuria or abdominal pain. The urine was bright, without grit or smell. There were no other complaints and she had never had this before. Our patient was working as a physiotherapist and usually ran 40–50 kilometres a week. She had already run a marathon three times. At physical examination, we found a healthy, slim woman with a blood pressure of 126/80 mmHg, heart rate of 60 beats per minute without abnormalities. Laboratory examination 30 min before and immediately after a 1.5 h run, are mentioned in Table 1
. After, but not before exercise, many normal red blood cells without casts with only a trace protein and free haemoglobin was seen in the urine.
|
We concluded it was postrenal, exercise-related macroscopic haematuria and found no reason for further urological examinations. We advised her to not completely empty the bladder prior to exercise. She restarted running and haematuria did not reappear.
Discussion
This patient had running-related, asymptomatic macroscopic haematuria within the urinalysis normal erythrocytes without casts with full recovery within 24 h after running. Red or russet discolouration of the urine after running cannot only be due to haematuria, but also to myoglobinuria or (march)haemoglobinuria. Prevalence of running-related haematuria is about 20–25% for a running distance of 21–90 km [1–3], with even higher urinary erythrocyte counts in 69% of athletes after a 9–14 km distance run [4]. Macroscopic haematuria was found mainly in long-distance runners (>10 km) and appears usually to be asymptomatic. It is usually most pronounced in the first urine voiding after exercise, normalizes often within 72 h after running and seems to be independent of the exercise intensity [1,3,5]. The pathogenesis of running-related haematuria is complex [5–7]. If at urinalysis erythrocytes are normal without dysmorphic features and without cellular casts, and the urine becomes normal within 72 h after exercise, no further diagnostic procedures are indicated. However, further analysis is necessary in the presence of persisting or repeated haematuria with abnormalities in the urinalysis. There is not much known about the treatment or prevention of exercise-related macroscopic haematuria, but running without completely voided bladder [5] and preventing dehydration [7] by high fluid intake, even in the form of beer, have been advised [8].
References
- Siegel AJ, Hennekens CH, Solomon HS, Boeckel B van. Exercise-related hematuria. Findings in a group of marathon runners. J Am Med Assoc 1979; 241: 391–392[Abstract]
- Reid RI, Hosking DH, Ramsey EW. Haematuria following a marathon run: source and significance. Br J Urol 1987; 59: 133–136[Medline]
- Kallmeyer JC, Miller NM. Urinary changes in ultra long-distance marathon runners. Nephron 1993; 64: 119–121[Medline]
- Fassett RG, Owen JE, Fairley J, Birch DF, Fairley KF. Urinary red-cell morphology during exercise. Br Med J 1982; 285: 1455–1457
- Blacklock NJ. Bladder trauma in the long-distance runner: `10 000 metres haematuria'. Br J Urol 1977; 49: 129–132[ISI][Medline]
- Abarbanel J, Benet AE, Lask D, Kimche D. Sports hematuria. J Urol 1990; 143: 887–890[Medline]
- Jones GR and Newhouse I. Sport-related hematuria: a review. Clin J Sport Med 1997; 7(2): 119–125[Medline]
- Bassler TJ. Beer as prevention for runner's haematuria. Br Med J 1979; ii: 1293
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Yusof, R. M. Leithauser, H. J. Roth, H. Finkernagel, M. T. Wilson, and R. Beneke Exercise-induced hemolysis is caused by protein modification and most evident during the early phase of an ultraendurance race J Appl Physiol, February 1, 2007; 102(2): 582 - 586. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||