School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
Ann Nutr Metab. 2020;76 Suppl 1:53-59. doi: 10.1159/000515022. Epub 2021 Mar 26.
Acute kidney injury (AKI) incidence (diagnosed by changes in serum creatinine [Cr]) following prolonged endurance events has been reported to be anywhere from 4 to 85%, and hypohydration may contribute to this. Whilst an increase in serum Cr indicates impaired kidney function, this might be influenced by muscle damage. Therefore, the use of other AKI biomarkers which can detect renal tubular injury may be more appropriate. The long-term consequences of AKI are not well understood, but there are some potential concerns of an increased subsequent risk of chronic kidney disease (CKD). Therefore, this brief review explores the effects of exercise training/competition on novel AKI biomarkers and the potential influence of fluid intake. The increase in novel AKI biomarkers following prolonged endurance events suggests renal tubular injury. This is likely due to the long duration and relatively high exercise intensity, producing increased sympathetic tone, body temperature, hypohydration, and muscle damage. Whilst muscle damage appears to be an important factor in the pathophysiology of exercise-associated AKI, it may require coexisting hypohydration. Fluid intake seems to play a role in exercise-associated AKI, as maintaining euhydration with water ingestion during simulated physical work in the heat appears to attenuate rises in AKI biomarkers. The composition of fluid intake may also be important, as high-fructose drinks have been shown to exacerbate AKI biomarkers. However, it is yet to be seen if these findings are applicable to athletes performing strenuous exercise in a temperate environment. Additionally, further work should examine the effects of repeated bouts of strenuous exercise on novel AKI biomarkers.
急性肾损伤 (AKI) 的发病率（通过血清肌酐 [Cr] 的变化来诊断）在长时间耐力事件后报告为 4%至 85%不等，而脱水可能对此有影响。虽然血清 Cr 的增加表明肾功能受损，但这可能受到肌肉损伤的影响。因此，使用其他可以检测肾小管损伤的 AKI 生物标志物可能更为合适。AKI 的长期后果尚不清楚，但存在慢性肾脏病 (CKD) 风险增加的潜在问题。因此，本篇简要综述探讨了运动训练/比赛对新型 AKI 生物标志物的影响，以及液体摄入的潜在影响。长时间耐力事件后新型 AKI 生物标志物的增加表明肾小管损伤。这可能是由于运动时间长且相对强度高，导致交感神经张力增加、体温升高、脱水和肌肉损伤。虽然肌肉损伤似乎是运动相关 AKI 病理生理学中的一个重要因素，但它可能需要同时存在脱水。液体摄入似乎在运动相关 AKI 中发挥作用，因为在热环境中模拟体力劳动时摄入水以保持水合作用似乎可以减轻 AKI 生物标志物的升高。液体摄入的成分也可能很重要，因为高果糖饮料已被证明会加重 AKI 生物标志物。然而，这些发现是否适用于在温带环境中进行剧烈运动的运动员，还有待观察。此外，应进一步研究反复剧烈运动对新型 AKI 生物标志物的影响。
