Ishikawa Isao
Division of Nephrology, Department of Internal Medicine, Kanazawa Medical University Uchinada, Ishikawa, Japan.
Nephron. 2002 Aug;91(4):559-70. doi: 10.1159/000065013.
Acute renal failure induced by rhabdomyolysis after strenuous exercise is well known. We describe here a new type of acute renal failure with severe loin pain which develops after anaerobic exercise (ALPE), for example, 200-meter track racing. The patients complained of severe loin pain several hours after exercise and presented at the emergency room. Since our first description 118 cases have been reported. The serum creatinine concentration was 4.7 +/- 2.9 mg/dl (mean +/- SD) at the initial examination and 6.0 +/- 3.0 mg/dl at maximum. Forty-nine of 96 cases whose serum uric acid levels were described revealed renal hypouricemia (51.0%). A specific risk factor is suggested by the fact that acute renal failure recurred after exercise in 20 of 118 cases. The creatine phosphokinase and serum myoglobin concentrations were normal or only slightly elevated, suggesting damaged type 2 muscle fibers. Renal computed tomography scans, performed several hours to 1-2 days after contrast medium administration, revealed multiple wedge-shaped areas of contrast enhancement. Forty-six of 50 cases examined by delayed computed tomography scan revealed bilateral wedge-shaped contrast enhancement. Although less efficient, radioisotopic scans, such as a methylene diphosphonate bone scan, have also been employed to detect patchy accumulation of isotopes in the kidneys (12 of 19 cases). The pathogenesis of ALPE may be patchy vasoconstriction of the renal vessels, because of its wedge-shaped distribution and its reversibility. Such vascular spasm would account for the renal pain. The prognosis was good, although 20 of 109 cases required dialysis treatment. In conclusion, there are two types of exercise-induced acute renal failure: one is the well-known myoglobin-induced acute renal failure, and the other is ALPE that may be nonmyoglobin induced or induced by myolysis of type 2 muscle fibers due to anaerobic exercise. One hundred and eighteen cases of ALPE were collected from the literature, and half of the cases were found to display renal hypouricemia.
剧烈运动后横纹肌溶解所致急性肾衰竭已为人熟知。我们在此描述一种新型急性肾衰竭，其发生于无氧运动（如200米跑道赛跑）后，伴有严重的腰痛（无氧运动后急性肾衰竭，ALPE）。患者在运动数小时后诉说严重腰痛，并前往急诊室就诊。自我们首次描述以来，已报告118例。初次检查时血清肌酐浓度为4.7±2.9mg/dl（均值±标准差），最高时为6.0±3.0mg/dl。在96例报告血清尿酸水平的病例中，49例出现肾性低尿酸血症（51.0%）。118例中有20例运动后急性肾衰竭复发，提示存在特定危险因素。肌酸磷酸激酶和血清肌红蛋白浓度正常或仅轻度升高，提示2型肌纤维受损。在给予造影剂后数小时至1 - 2天进行的肾脏计算机断层扫描显示多个楔形强化区域。50例接受延迟计算机断层扫描检查的病例中，46例显示双侧楔形强化。尽管效率较低，但放射性核素扫描，如亚甲基二膦酸盐骨扫描，也已用于检测肾脏中放射性核素的斑片状聚集（19例中有12例）。ALPE的发病机制可能是肾血管的斑片状血管收缩，因其呈楔形分布且具有可逆性。这种血管痉挛可解释肾痛。尽管109例中有20例需要透析治疗，但预后良好。总之，运动诱导的急性肾衰竭有两种类型：一种是众所周知的肌红蛋白诱导的急性肾衰竭，另一种是ALPE，可能由无氧运动导致的非肌红蛋白诱导或2型肌纤维溶解诱导。从文献中收集了118例ALPE病例，发现半数病例存在肾性低尿酸血症。
