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Case Reports
. 2019 Jul 29;9(2):92-101.
doi: 10.1159/000501877. eCollection 2019 May-Aug.

Exercise-Induced Acute Kidney Injury in a Police Officer with Hereditary Renal Hypouricemia

Yoshio Shimizu  1   2 , Keiichi Wakabayashi  1 , Ayako Totsuka  1   3 , Yoko Hayashi  1 , Shusaku Nitta  1 , Kazuaki Hara  1 , Maiko Akira  1 , Yasuhiko Tomino  4 , Yusuke Suzuki  3
Affiliations
Case Reports

Exercise-Induced Acute Kidney Injury in a Police Officer with Hereditary Renal Hypouricemia

Yoshio Shimizu et al. Case Rep Nephrol Dial. .

Abstract

Hereditary renal hypouricemia is characterized by hypouricemia with hyper-uric acid clearance due to a defect in renal tubular transport. Patients with hereditary renal hypouricemia have a higher risk of exercise-induced acute kidney injury (EAKI) and reduced kidney function. Although the best preventive measure is avoiding exercise, there are many kinds of jobs that require occupational exercise. A 27-year-old male police officer suffered from stage 3 AKI after performing a 20-m multistage shuttle run test. His mother had previously been diagnosed as having renal hypouricemia at another facility. The patient had reported having hypouricemia during a health check at a previous police station, but his serum uric acid concentration was within the normal range at our hospital. After treatment, he recovered from EAKI and exhibited low serum uric acid and hyper-uric acid clearance. Since the patient desired to continue his career requiring strenuous exercise, it was difficult to establish a preventive plan against the recurrence of EAKI. Patients with hereditary renal hypouricemia who must undergo strenuous occupational anaerobic exercise are at higher risk of developing EAKI than other workers. The risks of EAKI among patients with hypouricemia should be considered when undergoing physical occupational training.

Keywords: Acute kidney injury; Exercise; Hereditary renal hypouricemia; Police officer.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Pathophysiological model of renal hypouricemia at the proximal tubules. a Pathophysiological model of renal hypouricemia type 1. b Pathophysiological model of renal hypouricemia type 2.
Fig. 2
Fig. 2
The 20-m multistage shuttle run test. The participant continues to run back and forth between two lines, 20 m apart, within the interval of the beeps and has to increase the running speed gradually.
Fig. 3
Fig. 3
Abdominal CT image of the patient (non-enhanced). CT image of the patient shows no evidence of urolithiasis or hydronephrosis. The size and shape of both kidneys are normal.
Fig. 4
Fig. 4
Putative pathogenesis of EAKI. Strenuous exercise induces massive reactive oxygen species (ROS) which overcomes anti-oxidative activity of uric acid. Vascular constriction and endothelial damages play a key role in the development of AKI.
See this image and copyright information in PMC

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