Exercise-Induced Acute Renal Failure ALPE

Minimum rhabdomyolysis—non-myoglobinuric acute renal failure due to exercise-induced acute renal failure—ALPE (acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise) after sprint, short track event such as 200-m race, etc. 

Exercise-Induced Acute Renal Failure (ALPE)... 

Subsequently, we examined whether it is only patients with exercise-induced acute renal failure (ALPE) who show wedge-shaped contrast enhancement [15-18]. We performed delayed CT on a patient with ALPE and a patient with myoglobin uric acute renal failure (due to a malignant syndrome) when their serum creatinine levels were 3.0 and 1.5mg/dl, and compared the results. Wedge-shaped contrast enhancement was observed only in the patient with ALPE (Patient 19), and not in the patient with myoglobinuric acute renal failure. Diffuse contrast enhancement was noted (serum creatinine level, 3mg/dl) (Fig. 17). 

Fig. 17. Comparison of contrast enhancement 24h afterthe administration of contrast medium between exercise-induced acute renal failure (ALPE) and myoglobinuric acute renal failure (serum creatinine 3mg/dl). The patient with ALPE showed patchy wedge-shaped contrast enhancement, and the patient with myoglobinuric acute renal failure showed diffuse contrast enhancement...

Some patients have nontypical ALPE. Some do not clearly remember having exercised [1,28,29], and others do not complain of loin pain [30,31]. In addition, others concurrently develop myoglobinuric acute renal failure and exercise-induced acute renal failure (ALPE), and show the characteristics of both disorders [32,33],... 

This patient developed exercise-induced acute renal failure (ALPE) after participating in a 200-m race in an athletics meeting on a Health-Sports Day. When delayed CT showed patchy contrast enhancement, dynamic CT was performed in order to evaluate regional kidney function. The details are given in Chap. 2, Sect. 2. 

Table 3. Clinical findings in our 22 patients with exercise-induced acute renal failure (ALPE) ...

For this collection of data, we selected patients with acute kidney dysfunction or acute renal failure who met the above criteria for exercise-induced acute renal failure (ALPE), and who also matched our description. We collected a total of 155 patients with ALPE. The first 118 patients [2,3,22,27,30,34,35,37-95, Yamagata (personal communication, 1986), Ishikawa (unpublished results, 1994), Kadowaki (personal communication, 1996)] included 20 who we encountered before December 2000, and the remaining 37 patients [36,96-126] included 2 who we encountered between January 2001 and December 2004. 

As shown in Fig. 54, the types of exercise taken by the patients consisted of a track race (a short-distance sprint such as a 200-m race), soccer, a swimming race, baseball, weightlifting, and a bicycle race, in all of which an intense power output per second or per minute is repeated. However, a single 100-m race was less likely to cause exercise-induced acute renal failure (ALPE). Several 200-m or 100-m races frequently caused ALPE. Repeated anaerobic exercise may be a risk factor. 

Because of the severe pain, the physician (Patient 5) with exercise-induced acute renal failure (ALPE) made a self-diagnosis of acute pancreatitis. Initially, most patients are diagnosed as having ureteral stone, but some physicians diagnose lumbar pain or lumbar disc hernia. 

In 1990, we reported that 3 (23%) of 13 patients with ALPE had renal hypouricemia [3]. Previously, Erley et al. [28] had reported that patients with renal hypouricemia frequently developed acute renal failure. However, we were the first to report that these patients developed exercise-induced acute renal failure (ALPE) [3]. In our 3 patients with renal hypouricemia, the mean serum creatinine and uric acid levels in acute renal failure were 5.1 2.6mg/dl and 4.7 1.7mg/dl, respectively (Fig. 56). In the remaining 10 patients without renal hypouricemia, the mean serum creatinine and uric acid levels were 3.1 1.6mg/dl and 11.4 4.2mg/dl, respectively. In the recovery phase, these levels in the hypouricemia patients were 1.1 0.3 mg/dl and 0.8 0.2 mg/dl, respectively. The mean FEUA was 58.4 18.7%. In the 10 patients without hypouricemia, the mean serum creatinine, uric acid, and FEUA values were 1.1 0.1 mg/dl, 6.1 1.2 mg/dl, and 7.8 3.0%, respectively. 

At the onset of exercise-induced acute renal failure (ALPE), a slight fever was often observed, and most patients were positive for C-reactive protein (CRP). After considering the possibility of viral infection-associated ALPE, we investigated changes in the titers of various virus antibodies at onset and in the recovery phase. However, there were no significant changes. 

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