Department of Nephrology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-Shi, Chiba, 279-0021, Japan.
Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan.
BMC Nephrol. 2022 Nov 16;23(1):368. doi: 10.1186/s12882-022-02988-0.
March hemoglobinuria is caused by a hemolytic mechanism due to transient hematuria after physical exercise which, although rare, may lead to acute kidney injury. We report a case of a patient with march hemoglobinuria induced by kendo, which was diagnosed by the presence of Berlin blue iron staining in the proximal tubules through renal biopsy.
A 15-year-old male complained of fever (37 °C), general malaise, and nausea after hard kendo sessions. Laboratory findings revealed indirect bilirubin dominant hyperbilirubinemia (total bilirubin 3.8 mg/dL), high lactate dehydrogenase (LDH), and acute kidney injury (serum creatinine: 3.11 mg/dL and estimated glomerular filtration rate: 26 mL/min/1.73m). Urine test was positive for occult blood but without hematuria. Renal biopsy was performed to clarify the cause of renal injury, which showed minor glomerular abnormalities. Meanwhile, hemosiderin deposition was identified in the proximal tubules by Berlin blue iron staining, and lysosomes were observed to contain granular iron. In addition to clinical background of strenuous kendo exercise, renal biopsy led to a definitive diagnosis of march hemoglobinuria.
March hemoglobinuria is a hemolytic disease that can occur after intense exercise, especially kendo. Considering its rarity due to the lack of critical symptoms, it is important to note that occult blood-positive findings may be indicative of march hemoglobinuria if the patient underwent strenuous exercise. Therefore, clinicians should be aware of this possibility to provide timely and appropriate treatment.
行军性血红蛋白尿是由于运动后短暂血尿引起的溶血性机制，虽然罕见，但可能导致急性肾损伤。我们报告了一例由剑道引起的行军性血红蛋白尿病例，该病例通过肾活检在近端肾小管中存在柏林蓝铁染色而被诊断。
一名 15 岁男性在进行艰苦的剑道训练后出现发热（37°C）、全身不适和恶心。实验室检查结果显示间接胆红素占优势的高胆红素血症（总胆红素 3.8mg/dL）、高乳酸脱氢酶（LDH）和急性肾损伤（血清肌酐：3.11mg/dL 和估计肾小球滤过率：26mL/min/1.73m）。尿液检查潜血阳性，但无血尿。为明确肾损伤的原因进行了肾活检，结果显示肾小球有轻微异常。同时，通过柏林蓝铁染色发现近端肾小管中有含铁血黄素沉积，溶酶体中观察到颗粒状铁。除了剧烈剑道运动的临床背景外，肾活检明确了行军性血红蛋白尿的诊断。
行军性血红蛋白尿是一种溶血性疾病，可在剧烈运动后发生，尤其是剑道运动。由于缺乏关键症状，其罕见性，因此，如果患者进行了剧烈运动，潜血阳性的发现可能提示行军性血红蛋白尿。因此，临床医生应注意这种可能性，以便及时提供适当的治疗。
