Sports hematuria

Prevalence of anemia and iron deficiency and its association with body mass index in elite Japanese high school long-distance runners

OBJECTIVES

Anemia is a common condition in long-distance runners (LDRs). Recently, not only iron deficiency (ID) but also energy deficiency has been considered as a risk factor for anemia in athletes but no evidence has yet been established. The aim of this study was to investigate the prevalence of anemia and ID and the influence of body mass index (BMI) on anemia in high-school LDRs.

METHODS

The participants were 406 male and 235 female elite Japanese LDRs who competed in the All-Japan High-School Ekiden Championship 2019. They submitted their anthropometric data and results of a blood test within five days after the competition. The prevalence of anemia and ID and the influence of BMI on anemia were assessed retrospectively.

RESULTS

Mean hemoglobin concentrations (Hb) were 14.8 ± 0.9 g/dl in males and 13.2 ± 0.9 g/dl in females. The prevalence of anemia (Hb < 14 g/dl in males and < 12 g/dl in females) was significantly higher in males (16.3%) than females (6.4%), but males also showed higher prevalence of non-iron deficiency anemia (NIDA) than females (11.6% and 3.0%, respectively). No significant gender difference was found in the prevalence of iron deficiency anemia (IDA) (4.7% in males and 3.4% in females). ID (serum ferritin level < 25 ng/ml) was significantly more prevalent in females (37.4%) than males (18.5%). A binary logistic regression analysis revealed that low BMI was a contributor to anemia in females (odds ratios: 0.577 (95% CI: 0.369-0.901), p = 0.012).

CONCLUSION

In Japanese high-school LDRs, one in six males was anemic, but most males did not have ID. Conversely, one-third of females were diagnosed with ID. Lower BMI was identified as a risk for anemia in females, suggesting that leanness may also lead to anemia in females.

Urological issues in cyclists

Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.

Potential Use of Wearable Sensors to Assess Cumulative Kidney Trauma in Endurance Off-Road Running

(1) Background: This study aimed to explore wearable sensors' potential use to assess cumulative mechanical kidney trauma during endurance off-road running. (2) Methods: 18 participants (38.78 ± 10.38 years, 73.24 ± 12.6 kg, 172.17 ± 9.48 cm) ran 36 k off-road race wearing a Magnetic, Angular Rate and Gravity (MARG) sensor attached to their lower back. Impacts in g forces were recorded throughout the race using the MARG sensor. Two blood samples were collected immediately pre- and post-race: serum creatinine (sCr) and albumin (sALB). (3) Results: Sixteen impact variables were grouped using principal component analysis in four different principal components (PC) that explained 90% of the total variance. The 4th PC predicted 24% of the percentage of change (∆%) of sCr and the 3rd PC predicted the ∆% of sALB by 23%. There were pre- and post-race large changes in sCr and sALB (p ≤ 0.01) and 33% of participants met acute kidney injury diagnosis criteria. (4) Conclusions: The data related to impacts could better explain the cumulative mechanical kidney trauma during mountain running, opening a new range of possibilities using technology to better understand how the number and magnitude of the g-forces involved in off-road running could potentially affect kidney function.

Hemolysis Is Responsible for Elevation of Serum Iron Concentration After Regular Exercises in Judo Athletes

Serum iron concentration increases in marathon athletes after running due to mechanical destruction of red blood cells (hemolysis). This study was performed to examine whether serum iron concentration increases after regular Judo exercise, and if so, whether such post-exercise iron increase is caused by hemolysis. We examined biochemical parameters related to red blood cell and iron metabolism in 16 male competitive Judo athletes before and after traditional exercise training composed of basic movements and freestyle matchup. The parameters were adjusted for changes in plasma volume based on simultaneously measured albumin concentration. The red blood cell count, hemoglobin concentration, and hematocrit levels decreased significantly, by 6.0-8.4%, after Judo exercise. The serum iron concentration and transferrin saturation increased significantly, from 87 ± 34 μg/dL to 98 ± 29 μg/dL and from 27.1 ± 9.7% to 31.2 ± 9.0%, respectively. Furthermore, the serum free hemoglobin level increased by 33.9% (p < 0.05), and haptoglobin concentration decreased by 19.2% (p < 0.001). A significant negative correlation was observed between Δ haptoglobin concentration and Δ serum iron concentration (r = - 0.551, p = 0.027). The results of this study indicate that serum iron concentration increases significantly after Judo exercise due to hemolysis.

Exertional hematuria: definition, epidemiology, diagnostic and clinical considerations

Exertional hematuria can be considered a subcategory of exercise-induced hematuria, characterized by painless appearance of erythrocytes in urine after recent physical exercise, not directly attributable to external traumatic injuries to the genitourinary system, and spontaneously resolving with rest. Although its frequency has enormous heterogeneity, depending on the athlete population, duration and intensity of exercise, technique used for identifying or quantifying hematuria and relative diagnostic thresholds, what clearly emerges from the scientific literature is that a certain degree of hematuria is commonplace after non-contact sports, especially running. This exertional hematuria, which appears self-limiting, may be attributable to some frequently concomitant causes, involving organs of the genitourinary system, and mostly encompassing bladder or urethral injuries. Renal injuries caused by internal movements, vascular spasm and ischemia are also potential causes of increased glomerular permeability to erythrocytes, whilst the presence of preexisting genitourinary diseases cannot be ruled out, especially when post-exercise hematuria is recurrent or endures. Therefore, whenever hematuria is observed in a random urine specimen, recent sports performance (especially running) should be investigated and urinalyses scheduled for the following days. When no temporal association of hematuria with exercise can be found, when genitourinary traumas have been excluded or hematuria persists for >72 h, specific diagnostic investigations should be planned to identify possible genitourinary diseases.

Upper Tract Imaging in Patients with Initial or Terminal Hematuria Suggestive of Bleeding from the Lower Urinary Tract: How Often is the Upper Urinary Tract Responsible for the Hematuria?

Objectives

Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities.

Methods

We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities.

Results

In total, 57 patients (aged 23-95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging.

Conclusions

Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.

Fifteen-minute consultation: the management of microscopic haematuria

Haematuria can be a troublesome symptom with various different methods of presentation and aetiologies. Microscopic haematuria is a common coincidental finding often found when the patient has presented for another reason. We will discuss the subject of haematuria but will focus the majority of this article on the discussion of microscopic haematuria, including a definition, the important features to cover in the history and examination, aetiologies to suspect in children and infants, and a suggested approach to assessing these patients in secondary care.

Rhabdomyolysis After Ankle Strain and Light Cycling

A 35-year-old female presented to the emergency room with severe upper leg and back pain, which began 3 days after low-intensity cycling and falling from a stationary bike. She developed rhabdomyolysis with a maximum serum creatine kinase level of 72,358 U/L. This case report demonstrates that rhabdomyolysis has a wide range and spectrum of causes and risk factors. Although uncommon, this condition can occur after low-intensity exercise despite absence of other significant risk factors. Thus, clinicians should maintain a high clinical suspicion when initial history, physical examination, and laboratory tests suggest this diagnosis.

Influence of exhaustive aerobic exercise on some cytokines and serum iron parameters in canine experimental model

The aim of the experiment was to study the effect of exhaustive exercise on some cytokines and iron status parameters. We used 12 male, mongrel dogs divided into two groups – animals from experimental group were submitted to exercise at moderate intensity with exhaustion as the end-point; animals from control group did no exercise. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), hepcidin prohormone, serum iron (SI), total iron binding capacity (TIBC) and transferrin saturation (TS) were measured before exercise (BE), right after exercise (0 hour) and on 2, 4, 24, 48 and 72 hours after exercise. SI, TIBC and TS were measured also on day 7 and 14 after exercise. Serum levels of TNF-α increased after the exhaustive exercise. Serum levels of IL-6 demonstrated an increase at 0 hour, but increase was not statistically significant compared to BE level. Serum levels of hepcidin prohormone marked a slight increase 48 hours after the exercise, but change was insignificant. Levels of SI decreased on hour 72 (P<0.01) and on day 7 (P<0.01) and 14 (P<0.05) after the exercise, as compared to BE level. Similar were changes in TS. TIBC decreased on 4, 24 and 72 hours (P<0.05) after exercise, but only compared to control group. In conclusion, exhaustive exercise causes inflammatory response and a significant decrease in SI levels.

Work-up of hematuria

Hematuria is a common clinical manifestation of diseases affecting the urinary system. Sometimes it may not represent any underlying disease and is of no clinical significance, especially when it is transient in young adult patients. However, it may represent underlying intrinsic kidney disease or malignancy in patients, even if transient. Therefore, detection of hematuria in the appropriate clinical setting and further investigation based on the individual clinical scenario helps establish correct diagnosis and guide further management. This article discusses the etiologies and workup of hematuria.

Influence of body mass loss and myoglobinuria on the development of muscle fatigue after a marathon in a warm environment

The aim of this study was to determine the changes in body mass and myoglobinuria concentration in recreational runners during a marathon in a warm environment, and the relation of these changes to muscle fatigue. We recruited 138 amateur runners (114 men and 24 women) for the study. Before the race, leg muscle power output was measured during a countermovement jump on a force platform, body weight was measured, and a urine sample was obtained. Within 3 min of race completion (28 °C; 46% relative humidity), the runners repeated the countermovement jump, body weight was measured again, and a second urine sample was obtained. Myoglobin concentration was determined in the urine samples. After the race, mean body mass reduction was 2.2% ± 1.2%. Fifty-five runners (40% of the total) reduced their body mass by less than 2%, and 10 runners (7.2%) reduced their body mass by more than 4%. Only 3 runners increased their body mass after the marathon. Mean leg muscle power reduction was 16% ± 10%. Twenty-four runners reduced their muscle power by over 30%. No myoglobin was detected in the prerace urine specimens, whereas postrace urinary myoglobin concentration increased to 3.5 ± 9.5 μg·mL(-1) (p < 0.05). Muscle power change after the marathon significantly correlated with postrace urine myoglobin concentration (r = -0.55; p < 0.001), but not with body mass change (r = -0.08; p = 0.35). After a marathon in a warm environment, interindividual variability in body mass change was high, but only 7% of the runners reduced their body mass by more than 4%. The correlation between myoglobinuria and muscle power change suggests that muscle fatigue is associated with muscle breakdown.

Terminal hematuria associated with oral isotretinoin treatment in a patient with acne vulgaris

Hematuria is defined as the abnormal presence of red blood cells in the urine and is commonly divided into gross and microscopic hematuria. Terminal hematuria occurs at the end of the urine stream and may have a prostatic, bladder, or trigonal cause. Here, we present a 16-year-old boy who developed terminal hematuria after 1 month of treatment with isotretinoin for acne vulgaris. This side effect of isotretinoin is not reported in the literature. This is the first case report.

The effect of exercise on urinary gamma-glutamyltransferase and protein levels in elite female karate athletes

PURPOSE

Post exercise proteinuria and increased urinary Gamma-Glutamyl transferase (GGT) levels can be indicative of exercise-induced renal damage. The aim of this investigation is to study the effect of one session of intensive training on renal damage markers and compare their values to those 6 hours after training.

METHODS

In this cross-sectional study with pre- and post-test design, 10 elite volunteer female athletes were selected and participated in one training session (2 hours). Urine samples were collected before training, one hour after training, and 6 hours after training. Urinary protein (Pr), creatinine (Cr), and GGT values were measured through laboratory methods and then Pr/Cr and GGT/Cr ratios were computed.

RESULTS

There were significant differences between values of protein, GGT and Creatinine in the three sampling phases (P<0.05). However, no significant differences were observed between values for GGT/Cr and Pr/Cr ratio. There were significant differences between the mean values of Creatinine, protein and GGT within pre-exercise and 1 hour post-exercise and within 1 hour post-exercise and 6 hours post-exercise (P<0.05).

CONCLUSION

It seems that a session of karate training does not result in renal damage and athletes can continue training after 6 hours.

Muscle damage and its relationship with muscle fatigue during a half-iron triathlon

Background

To investigate the cause/s of muscle fatigue experienced during a half-iron distance triathlon.

Methodology/Principal Findings

We recruited 25 trained triathletes (36±7 yr; 75.1±9.8 kg) for the study. Before and just after the race, jump height and leg muscle power output were measured during a countermovement jump on a force platform to determine leg muscle fatigue. Body weight, handgrip maximal force and blood and urine samples were also obtained before and after the race. Blood myoglobin and creatine kinase concentrations were determined as markers of muscle damage.

Results

Jump height (from 30.3±5.0 to 23.4±6.4 cm; P<0.05) and leg power output (from 25.6±2.9 to 20.7±4.6 W · kg⁻¹; P<0.05) were significantly reduced after the race. However, handgrip maximal force was unaffected by the race (430±59 to 430±62 N). Mean dehydration after the race was 2.3±1.2% with high inter-individual variability in the responses. Blood myoglobin and creatine kinase concentration increased to 516±248 µg · L⁻¹ and 442±204 U · L⁻¹, respectively (P<0.05) after the race. Pre- to post-race jump change did not correlate with dehydration (r = 0.16; P>0.05) but significantly correlated with myoglobin concentration (r = 0.65; P<0.001) and creatine kinase concentration (r = 0.54; P<0.001).

Conclusions/significance

During a half-iron distance triathlon, the capacity of leg muscles to produce force was notably diminished while arm muscle force output remained unaffected. Leg muscle fatigue was correlated with blood markers of muscle damage suggesting that muscle breakdown is one of the most relevant sources of muscle fatigue during a triathlon.

Hematuria in a runner after treatment with whole body vibration: a case report

The use of whole body vibration (WBV) for therapeutic purposes is far from being standardized and the training protocols reported in the literature vary considerably. Currently, the optimal threshold for a beneficial effect is undetermined, and caution regarding potential health risks due to WBV is always necessary. In this case report, we present a 34-year-old otherwise healthy elite athlete (steeplechase runner) who suffered two episodes of hematuria (HT) after WBV training. Shortly after the third WBV, he had an episode of bright red urine. Seven days later, following the next WBV session (and again before his daily running session), a reddish-colored urine reappeared. Our patient was advised to stop WBV training and to take fluid before and during exertion. He did not experience any episode of HT during a 1-year follow-up with periodic check-ups, in spite of the continuation of his sporting career. The concomitance of the two types of trauma - daily running and WBV - could have been critical in this case for producing HT. In particular, we think that platforms providing side-alternating vibration (such as the Galileo platform) may pose some health risks if the feet are positioned too far from the axis of rotation.

Incidence of anemia and iron deficiency in strenuously trained adolescents: results of a longitudinal follow-up study

PURPOSE

Combat soldiers have a higher prevalence of anemia than age- and gender-matched civilians. This may be caused by hemodilution, which is typical among athletes, or by reduced body iron stores. The aim of this study was to investigate the incidence of iron-deficiency anemia in recruits to the Israel Defense Force after 6 months of training.

METHODS

Blood was collected from recruits before training. After 6 months of follow-up, 153 paired blood samples were collected from the initial cohort. Total blood count and serum iron, transferrin, and ferritin were measured at both time points. Soluble transferrin receptor (sTfR) was measured in 119 of the paired samples and the sTfR/log ferritin ratio was calculated.

RESULTS

At recruitment, mean hemoglobin concentration was 14.7 +/- .9 g/dl. Iron-transferrin saturation was 34.1% +/- 13.6%, and mean ferritin concentration was 53.6 +/- 33.2 ng/ml. Anemia prevalence (Hb <14 g/dl) was 17.6%, and 14.9% of participants were iron-deficient (ferritin <22 mg/dl). At 6 months, 50.3% of the cohort was anemic, and 27.3% demonstrated iron-store depletion. Paired analysis showed an average reduction of .83 g/dl in hemoglobin (p < .001), and of 9.8 mg/dl in ferritin (p < .001). sTfR increased from 1.9 to 2.1 mg/dl (p < .003) among recruits who became anemic. Half of the recruits experienced mild anemia after 6 months of training. Iron store depletion was observed among 24.5% of the cohort after training, as opposed to 15% at recruitment. Overall, these changes were not accompanied by a significant increase in sTfR, but among the subset of anemic subjects, there was a slight increase in index value.

CONCLUSIONS

In half of the cases, new-onset anemia was attributable to iron deficiency, and in the remainder, to hemodilution.

Renal trauma: evaluation, management, and return to play

Renal injuries can occur in sports participation by both traumatic and atraumatic mechanisms. Atraumatic injury includes exercise-induced proteinuria, which is seen in intense exercise and usually resolves quickly without kidney damage. Exercise-induced hematuria typically resolves within 24-48 h without need for further investigation. Traumatic kidney injuries occur as a result of blunt abdominal trauma, flank trauma, or penetrating injury. Microscopic hematuria is the most common finding in these situations. In the absence of associated hypotension, or without macroscopic hematuria, further imaging rarely is needed. The American Association for the Surgery of Trauma (AAST) organ injury severity scale for the kidney is a useful and validated tool to determine who is likely to require further work-up and surgery. The athlete with the solitary kidney appears to have low risk for kidney loss with participation in both contact and noncontact sports.

The association between hematological and inflammatory factors and stress fractures among female military recruits

BACKGROUND

With the growing number of females accepted for combat-related military duties in the Israeli Defense Forces, their special needs should be addressed. Previous studies on females in combat training have found a high prevalence of iron deficiency at recruitment as well as an increased rate of stress fractures (SF) and overuse injuries during training when compared with males. The aim of this study was to assess the correlation between hematological and inflammatory variables and SF occurrence among military recruits during basic training.

METHODS

Three gender-integrated light infantry units were followed prospectively. Female recruits inducted for medic and dental assistants' courses were followed for comparison. Hemoglobin, iron, transferrin, ferritin, C-reactive protein, and interleukin-6 levels were measured for all participants at recruitment and at 2 and 4 months of training. SF were diagnosed radiographically or scintigraphically according to the Israeli Defense Forces protocol.

RESULTS

A total of 438 subjects were recruited (female combatants = 227, male combatants = 83, noncombatant females = 128). At induction, 18% of female combatants had anemia compared with 8% of males and 19% of noncombatants. Iron deficiency was noted in 40%, 6%, and 38%, respectively. There were no clinically significant changes during training. Twelve percent of female combatants developed SF, whereas none occurred among male combatants or noncombatants. Subjects sustaining an SF had significantly lower levels of serum iron and iron saturation.

CONCLUSIONS

A high incidence of anemia as well as iron deficiency was found in this young asymptomatic cohort, with no significant change during training. The lower level of iron in female combatants sustaining SF warrants further investigation.

Evaluation of exercise testing for subjects with isolated proteinuria and/or hematuria of unclear significance

BACKGROUND

A frequent problem that family doctors face is the meaning of small quantities of blood or protein in urine samples. Patients with this problem are often either neglected or referred to specialists for complex, expensive, and often invasive diagnostic procedures. Exercise testing has never been considered in nephrology, except for some attempts in diabetic patients.

METHODS

We report on a study conducted over 12 years with patients referred for slight hematuria and/or proteinuria to determine whether exercise testing could be a diagnostic aid in some or all of them. We performed exercise testing using a treadmill preceded and followed by urine analysis, with a kidney biopsy within 10 days. Of the 94 patients enrolled in the study, only those with a positive exercise test turned out to have parenchymal nephropathy. At the end of the study, we simplified the quantification of exertion, dispensing with the treadmill and drastically reducing the number of urinary parameters considered.

RESULTS

In patients with histological evidence of kidney damage, most of the variables increased significantly after the test. Statistical analysis also showed that determination of proteinuria and hematuria alone guaranteed maximum predictability. We found that it is also possible to simplify the quantification of effort/exertion and to drastically reduce the number of urinary parameters and still obtain significant results.

CONCLUSIONS

Exercise testing provides useful information about the significance of microhematuria and proteinuria, reducing the number of cases that need to be referred to specialists. The method needs to be validated in other studies, but our results suggest that family doctors could use simple dipsticks to screen the many cases of microhematuria or proteinuria observed in daily practice. The method seems useful in eliminating doubts and unnecessary diagnostic costs.

Mountainbiker's hematuria: a case report

Although exercise-induced hematuria is a well known finding in long distance running, it is extremely rare in cycling. We describe a case of gross atraumatic hematuria after mountainbiking. The only pathologic finding in our patient was a small hyperemic zone in the bladder mucosa suggesting a local traumatic origin due to repeated contact of the flaccid bladder wall against the bladder base. This in contrast with the renal origin commonly seen in marathon runners. It is a benign hematuria that usually resolves within a day without specific treatment. The best treatment is prevention by means of good bladder filling. Neoplasm of the urothelium should be ruled out in differential diagnosis.

Iron-regulatory protein hepcidin is increased in female athletes after a marathon

The propose of this study was to determine the influence of marathon race on hepcidin excretion in female athletes (age 26-45 years). Urine samples were taken before, immediately after, 1 and 3 days after the race. In the average, hepcidin transiently increased at day 1 from 32 to 85 ng/mg creatinine. We propose that the frequently observed iron deficiency of females runners is caused by elevated hepcidin levels.

Prevalence of iron deficiency and anemia among strenuously trained adolescents

PURPOSE

There is a lack of awareness among physicians, dieticians, and public health planners as to the prevalence of iron deficiency and anemia among adolescents undergoing strenuous physical training. The aim of this study was to estimate the prevalence of iron deficiency and anemia among male adolescents undergoing such activity.

METHODS

We studied 292 male adolescents on the day of entry into a volunteer military unit. Hemoglobin (Hb), mean corpuscular volume, ferritin, iron, iron-transferrin saturation, and soluble transferrin receptor (TfR) were measured, and TfR-F index was calculated.

RESULTS

The mean Hb level (+/-SD) in the study population was 14.7 +/- .9 g/dL (range, 10.8-16.8 g/dL), mean ferritin level was 50.6 +/- 32.6 ng/mL (range, 5.4-162.5 ng/mL), and mean iron level was 97.1 +/- 39.9 microg/dL (range, 24-267 microg/dL). The prevalence of anemia (Hb <14 g/dL) was 18.5%, and 3.4% had Hb concentrations less than 13 g/dL. Iron deficiency (ferritin <22 ng/mL) was present in 18% of the subjects, and 11.3% had ferritin levels less than 17 ng/mL. The mean soluble transferrin receptor concentration was 1.9 +/- .8 mg/L, and the mean TfR-F index was 1.21 +/- .57.

CONCLUSIONS

Nearly 19% of the study subjects had mild anemia at recruitment, and depletion of iron stores was observed among 18%. Overall, these changes were not accompanied by a significant increase in soluble TfR. This high prevalence is most likely the result of "sports anemia" due to the intense physical training regimen adopted prior to their recruitment.

Sport hematuria in boys: a provocative test

Sports hematuria has been described in adult athletes. We report on two boys with gross hematuria after soccer matches. Urinalysis was negative for hematuria at the first visit. A simple test of effort provoked the phenomenon and allowed the detection of the post-renal origin of bleeding and the rapid resolution of hematuria. Such a test may be particularly helpful after the first episode, when it is problematic to postulate a cause-effect relationship between exercise and hematuria on the basis of the patients' history.

Hematologic Disorders in the Athlete

Optimal athletic performance depends on proper function of many organs, including the blood. This is underscored by the focus of endurance athletes on increased hemoglobin through training at altitude or exogenous erythropoietin. Several other aspects of the hematologic system can also affect or be influenced by physical activity. In this article, the authors briefly discuss inherited abnormalities of the blood that can manifest themselves in athletes. We then discuss the effects of exercise on the blood, and acquired abnormalities of blood cells or coagulation parameters that occur in athletes, and that can influence performance or cause other symptoms.

The Vicious Cycling: Bicycling Related Urogenital Disorders

PURPOSE

Bicycle riding is one of the most popular means of transportation, recreation, fitness and sports among millions of people of all ages who ride on road and off road, using a variety of bicycle types. It is also a readily available form of aerobic non-impact exercise with established cardiovascular beneficial effects. Bicycles are also a common source of significant injuries. This review focuses upon the specific bicycling related overuse injuries affecting the genitourinary tract.

MATERIALS AND METHODS

MEDLINE search of the literature on bicycling and genitourinary disorders was performed using multiple subject headings and additional keywords. The search yielded overall 62 pertinent articles. We focused primarily on the most prevalent related disorders such as pudendal nerve entrapment, erectile dysfunction and infertility. The potential effect of bicycling on serum PSA level was also discussed in depth in view of its recognized clinical importance. Infrequent disorders, which were reported sporadically, were still addressed, despite their rarity, for the comprehensiveness of this review.

RESULTS

The reported incidence of bicycling related urogenital symptoms varies considerably. The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50-91% of the cyclists, followed by erectile dysfunction reported in 13-24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.

CONCLUSIONS

Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.

A handicap in treatment and follow-up of ankylosing spondylitis: sports hematuria

A 19-year-old male patient with a 7-year history of ankylosing spondylitis (AS) was admitted to our clinic. After completion of the laboratory and radiologic investigations, we prescribed an exercise program besides his medical therapy. After these exercises, he complained of painless dark urine sometimes with passage of clot that disappeared the following day. To investigate this hematuria related with exercise, further laboratory and radiologic studies were carried out. After exclusion of the other causes of hematuria, we concluded that the diagnosis was sports hematuria.

Hematological indices and iron status in athletes of various sports and performances

PURPOSE

Alterations of the red blood cell system and iron metabolism can influence physical performance. On the other hand, exercise can influence hematological variables. The purpose of this epidemiological study was to investigate the characteristics of the red blood cell system and the iron metabolism in athletes of different sporting disciplines and at different levels of performance.

METHODS

We studied 851 male subjects (747 athletes, 104 untrained controls). Hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), iron, transferrin, ferritin (Fer), and haptoglobin were analyzed in standardized blood samples, obtained after 2 d of rest, considering levels of performance (internationally, nationally, locally competitive, and leisure time), distinctive sporting category (endurance- (END), strength- (POW), and mixed-trained (MIX)), and, within endurance athletes, distinctive disciplines (cycling (CYC) and running (RUN)).

RESULTS

No difference was found between athletes and controls in Hb and Hct. Reduced Hb, Hct, and RBC levels were observed in END compared with POW and MIX. These findings can mainly be attributed to exercise-induced plasma volume expansion, and only to a lesser degree and in selected athlete populations to hemolysis, as low haptoglobin is only observed in RUN, not in CYC, suggesting that not exercise itself but the "traumatic" movement of running might trigger the destruction of red blood cells. Physical activity of increasing duration and workloads (leisure time compared with competitive athletes) leads to decreased Fer levels in athletes, disregarding their discipline, but more pronounced in RUN.

CONCLUSION

Physical training itself has no significant effect on selected hematological variables in athletes compared with untrained controls. The specific type and duration of exercise is of major importance in the adaptations of the blood cell system and the iron metabolism.

High-performance liquid chromatography coupled to enzyme-amplified biochemical detection for the analysis of hemoglobin after pre-column biotinylation

The determination of proteins with enzyme-amplified biochemical detection (EA-BCD) coupled on-line with high-performance liquid chromatography (HPLC) is demonstrated. The EA-BCD system was developed to detect biotin-containing compounds. Hemoglobin, which was used as a model compound, was biotinylated prior to sample introduction. Several biotinylation parameters, such as pH and removal of excess biotinylation reagent, were investigated. After biotinylation samples were introduced to HPLC followed by EA-BCD. To the HPLC effluent, alkaline phosphatase label streptavidin (S-AP) was added, which possesses high affinity to biotin and biotin-containing compounds. Excess S-AP was removed by means of an immobilized biotin column followed by substrate addition. The non-fluorescent substrate is converted to a highly fluorescent product by the enzyme label. A detection limit of 2 femtomol biotinylated Hb was achieved with good reproducibility and linearity. However, biotinylation at low analyte concentration suffers from low yield due to slow reaction kinetics. Finally, Hb was successfully extracted from urine with a recovery of 94%.

Abdominal injuries and sport

Serious abdominal injuries resulting from sport are rare. The potential for misdiagnosis is significant and the consequences may be serious. Patients with abdominal pain should be taken very seriously and investigated with appropriate diagnostic equipment. Sporting bodies have a responsibility to address safety within a particular sport and to change the rules where necessary as injury patterns are identified.

Asymptomatic urinary abnormalities. Hematuria and proteinuria

Asymptomatic urinary abnormalities including hematuria and proteinuria are commonly detected in routine urinalysis. They may be of benign etiology or indicative of more serious underlying disease. This article is intended to give clinicians a guide for evaluation of hematuria and proteinuria.

Haematuria, pigmenturia and proteinuria in exercising horses

The effects of exercise on urinary excretion of red blood cells, pigments (haemoglobin and myoglobin) and protein were studied in 8 mares performing treadmill exercise at speeds eliciting 40, 60 and 95% of the maximal oxygen consumption (VO2max). Gross haematuria and pigmenturia were observed in all horses during exercise at the 2 higher intensities, while these findings were detected in only one of 8 mares during exercise at 40% of the VO2max. For the remaining 7 mares exercised at 40% of the VO2max, increased urinary excretion of red blood cells (RBCs) and pigments was evident after centrifugation of urine samples and reagent strip analysis of the supernatant fractions. An increase in urine flow (UF) during exercise at 40% of the VO2max may have contributed to the infrequent observation of gross haematuria and pigmenturia during exercise at this intensity. A transient increase in UF following exercise at 60 and 95% of the VO2max resulted in rapid resolution of gross haematuria and pigmenturia, but increased urinary excretion of RBCs and pigments remained evident by reagent strip analysis for up to 60 min following exercise. Mean +/- s.e. urinary protein excretion increased from a resting value of 2.2 +/- 0.2 mg/min to 5.6 +/- 0.9, 14.5 +/- 4.7 and 78.4 +/- 18.6 mg/min after exercise at 40, 60 and 95% of the VO2max, respectively. These results demonstrate that exercise induced haematuria and pigmenturia and post exercise proteinuria are common in horses. Their occurrence is transient and does not appear to be associated with any lasting changes in renal function.

Haematological and iron-related parameters of male endurance and strength trained athletes

To obtain more information on the effects of long-lasting endurance and strength training on the constituents of the blood, several haematological and iron-related parameters were measured at rest in 39 male athletes from the Polish team who participated in the Olympics in Seoul in 1988. The athletes were divided into two groups: endurance-trained subjects (group E, cyclists, canoeists and rowers; n = 22) and strength-trained subjects (group S, wrestlers and judo; n = 17). The control group was composed of untrained male subjects (n = 48). Blood samples were taken from an antecubital vein with the subject at rest for determinations of haemoglobin concentration ([Hb]), packed cell volume (PCV), erythrocyte (RBC) and reticulocyte count, plasma free haemoglobin concentration, haptoglobin concentration, serum iron, transferrin concentration and ferritin concentrations ([Ferr]); red blood cells were used for estimation of glutamato-oxalate transaminase (GOT) activity and free erythrocyte protoporphyrin concentration ([FEP]). The mean [Hb], PVC, RBC measured in the E athletes were significantly lower than in the control group but were comparable to those obtained in the S atheletes. There were no significantly differences in the haematological indices [mean corpuscular volume (MCV), mean copuscular haemoglobin and mean corpuscular haemoglobin concentration] between the groups of atheletes and the control group. A significant increase in reticulocytosis and GOT activity was observed in the endurance-trained athletes. No impairment of erythropoiesis was observed as indicated by several sensitive markers of haemoglobin formation (FEP, MCV and inspection of blood smears) in the athletes.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical profiles of gross hematuria in autosomal dominant polycystic kidney disease

There is little information on the characteristics, management, or sequelae of gross hematuria in autosomal dominant polycystic kidney disease (ADPKD). Therefore, we obtained detailed information regarding gross hematuria in 191 adult ADPKD subjects. Forty-two percent (N = 81) experienced at least one episode of gross hematuria. The mean age of the initial episode was 30 +/- 1 years; only 10% of subjects reported the first episode before age 16. Twenty-three percent of those with gross hematuria had experienced more than six occurrences. Sixty-two percent of patients with bleeding indicated a presumptive precipitating event, most commonly urinary tract infection (42% overall, 61% of females v 17% of males, P less than 0.01), or sports or strenuous activity (20% of males v 11% of females, NS). In 56% of subjects, the episode persisted for 2 to 7 days. Hypertensive ADPKD subjects were more likely to have gross hematuria than normotensive subjects (48% v 30%, P less than 0.02) and those with gross hematuria had larger renal size (820 +/- 87 v 588 +/- 52 cm3, P less than 0.03). Moreover, those subjects with more episodes of gross hematuria had a higher serum creatinine concentration than those with fewer episodes (serum creatinine: 0 episodes, 120 +/- 10 v greater than 5 episodes, 190 +/- 30 mumol/L, P less than 0.04 [1.4 +/- 0.1 v 2.1 +/- 0.3 mg/dL]). This association suggests that, although self-limited, cumulative episodes of gross hematuria may have an unfavorable impact on long-term renal function.