Sport-related hematuria: a review

Abstract

Objective: To present an overview and models of the potential causes and implications of sport-related hematuria in an athletic population as provided by a literature review.

Data sources: A total of 64 published scientific articles have been utilized to provide a review of sport-related hematuria.

Study selection: Reviewed studies were selected on the basis that they provided informative findings about the possible mechanisms of sport-related hematuria attributed to exercise duration and intensity. These studies used both normal adult and athletic populations.

Data extraction: A review of the literature on the potential mechanisms of sport-related hematuria led to the classification of these mechanisms as either exercise duration related or exercise intensity related.

Data synthesis: Research has revealed an increased prevalence of hematuria in athletes. The mechanisms responsible may be traced to different sources or a combination thereof. Many explanations have been directed toward a potential cause; foot-strike hemolysis, renal ischemia, hypoxic damage to the kidney, the release of a hemolyzing factor, bladder and/or kidney trauma, nonsteroidal anti-inflammatory drugs, dehydration, increased circulation rate, myoglobinuria release, and the peroxidation of red blood cells. These mechanisms are presented in two models depicting the influence of either exercise intensity or exercise duration on sport-related hematuria.

Conclusions: Athletes, coaches, and sports medicine professionals should be aware of this condition because frequent high-intensity and/or long-duration workouts and competitions may promote the symptoms. Repeated red blood cell loss through the urine may be a contributing factor toward promoting anemic conditions in competitive athletes. Recognition of the potential mechanisms can spare the time and expense of invasive testing.