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Joyce KE, Balanos GM, Bradley C, Fountain A, Bradwell AR, Lucas SJE. Post-exercise urinary alpha-1 acid glycoprotein is not dependent on hypoxia. J Appl Physiol (1985) 2021; 132:261-269. [PMID: 34762527 PMCID: PMC8791839 DOI: 10.1152/japplphysiol.00476.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Proteinuria is a transient physiological phenomenon that occurs with a range of physical activities and during ascent to altitude. Exercise intensity appears to dictate the magnitude of postexercise proteinuria; however, evidence also indicates the possible contributions from exercise-induced hypoxemia or reoxygenation. Using an environmental hypoxic chamber, this crossover-designed study aimed to evaluate urinary alpha-1 acid glycoprotein (α1-AGP) excretion pre/postexercise performed in hypoxia (HYP) and normoxia (NOR). Sixteen individuals underwent experimental sessions in normoxia (NOR, 20.9% O2) and hypoxia (HYP, 12.0% O2). Sessions began with a 2-h priming period before completing a graded maximal exercise test (GXT) on a cycle ergometer, which was followed by continuation of exposure for an additional 2 h. Physiological responses (i.e., blood pressure, heart rate, and peripheral oxygenation), Lake Louise Scores (LLSs), and urine specimens (analyzed for albumin and α1-AGP) were collected pre- and postexercise (after 30, 60, and 120 min). Peak power output was significantly reduced in HYP (193 ± 45 W) compared with NOR (249 ± 59 W, P < 0.01). Postexercise urinary α1-AGP was greater in NOR (20.04 ± 14.84 µg·min−1) than in HYP (15.08 ± 13.46 µg·min−1), albeit the difference was not significant (P > 0.05). Changes in urinary α1-AGP from pre- to post-30 min were not related to physiological responses or performance outcomes observed during GXT in NOR or HYP. Despite profound systemic hypoxemia with maximal exercise in hypoxia, postexercise α1-AGP excretion was not elevated above the levels observed following normoxic exercise. NEW & NOTEWORTHY By superimposing hypoxic exposure and maximal exercise, we were able to investigate the impact of hypoxia on postexercise proteinuria. Urinalysis for α1-AGP (via particle-enhanced immunoturbidimetry) in specimens collected pre-/postexercise enabled the sensitive detection of altered glomerular permeability. Data indicated that exercise intensity, rather than the degree of exercise-induced hypoxemia, determines postexercise proteinuria.
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Affiliation(s)
- Kelsey Elizabeth Joyce
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - George M Balanos
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christopher Bradley
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Amy Fountain
- Research & Development, The Binding Site Ltd, Birmingham, United Kingdom
| | - Arthur Randell Bradwell
- The Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J E Lucas
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Kuru O, Basralı F, Koçer G, Şentürk Ü. Nitric oxide involvement in post-exercise proteinuria of sedentary young men. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zubac D, Paravlic A, Reale R, Jelaska I, Morrison SA, Ivancev V. Fluid balance and hydration status in combat sport Olympic athletes: a systematic review with meta-analysis of controlled and uncontrolled studies. Eur J Nutr 2019; 58:497-514. [DOI: 10.1007/s00394-019-01937-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
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Koçer G, Basralı F, Kuru O, Şentürk ÜK. The Renin-Angiotensin System, Not the Kinin-Kallikrein System, Affects Post-Exercise Proteinuria. Nephron Clin Pract 2018; 139:299-304. [PMID: 29772567 DOI: 10.1159/000489506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Temporary proteinuria post-exercise is common and is caused predominantly by renal haemodynamic alterations. One reason is up-regulation of angiotensin II (Ang II) due to the reducing effect of angiotensin-converting enzyme (ACE) inhibitors. However, another, ignored, reason could be the kininase effect of ACE inhibition. This study investigated how ACE inhibition reduces post-exercise proteinuria: by either Ang II up-regulation inhibition or bradykinin elevation due to kininase activity inhibition. METHODS Our study included 10 volunteers, who completed 3 high-intensity exercise protocols involving cycling at 1-week intervals. The first protocol was a control arm, the second evaluated the effect of ACE inhibition and the third examined the effect of angiotensin type 1 receptor blockade. Upon application, both agents reduced systolic and diastolic blood pressure; however, there were no statistically significant -differences. In addition, total protein, microalbumin and -β2-microglobulin excretion levels in urine specimens were analysed before, 30 min after and 120 min after the exercise protocols. RESULTS Total protein levels in urine samples were elevated in all 3 protocols after 30 min of high-intensity exercise, compared to baseline levels. However, both ACE inhibition and angiotensin type 1 receptor blockade suppressed total protein in the 30th min. In each protocol, total protein levels returned to the baseline after 120 min. Urinary microalbumin and β2-microglobulin levels during the control protocol were significantly higher 30 min post-exercise; however, only angiotensin type 1 receptor blockade suppressed microalbumin levels. CONCLUSION The results indicated Ang II up-regulation, not bradykinin elevation, plays a role in post-exercise proteinuria.
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Affiliation(s)
- Günnur Koçer
- Department of Physiology, Near East University, Medical Faculty, Nicosia, Cyprus
| | - Filiz Basralı
- Department of Physiology, Akdeniz University, Medical Faculty, Antalya, Turkey
| | - Oktay Kuru
- Department of Physical Therapy and Rehabilitation, Muğla Sıtkı Koçman University, Faculty of Health Sciences, Muğla, Turkey
| | - Ümit Kemal Şentürk
- Department of Physiology, Akdeniz University, Medical Faculty, Antalya, Turkey
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Zubac D, Reale R, Karnincic H, Sivric A, Jelaska I. Urine specific gravity as an indicator of dehydration in Olympic combat sport athletes; considerations for research and practice. Eur J Sport Sci 2018; 18:920-929. [PMID: 29746803 DOI: 10.1080/17461391.2018.1468483] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Urine specific gravity (USG) is the most commonly reported biochemical marker used in research and applied settings to detect fluid deficits in athletes, including those participating in combat sports. Despite the popularity of its use, there has been a growing debate regarding the diagnostic accuracy and the applicability of USG in characterizing whole-body fluid status and fluctuations. Moreover, recent investigations report universally high prevalence of hypohydration (∼90%) via USG assessment in combat sport athletes, often in spite of stable body-mass. Given the widespread use in both research and practice, and its use in a regulatory sense as a 'hydration test' in combat sports as a means to detect dehydration at the time of weigh-in; understanding the limitations and applicability of USG assessment is of paramount importance. Inconsistencies in findings of USG readings, possibly as a consequence of diverse methodological research approaches and/or overlooked confounding factors, preclude a conclusive position stand within current combat sports research and practice. Thus the primary aim of this paper is to critically review the literature regarding USG assessment of hydration status in combat sports research and practice. When taken on balance, the existing literature suggests: the use of laboratory derived benchmarks in applied settings, inconsistent sampling methodologies, the incomplete picture of how various confounding factors affect end-point readings, and the still poorly understood potential of renal adaptation to dehydration in combat athletes; make the utility of hydration assessment via USG measurement quite problematic, particularly when diet and training is not controlled.
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Affiliation(s)
- Damir Zubac
- a Science and Research Center Koper , Institute for Kinesiology Research , Koper , Slovenia.,c Faculty of Kinesiology , University of Split , Split , Croatia
| | - Reid Reale
- b Gatorade Sports Science Institute , Bradenton , FL , USA
| | - Hrvoje Karnincic
- c Faculty of Kinesiology , University of Split , Split , Croatia
| | | | - Igor Jelaska
- c Faculty of Kinesiology , University of Split , Split , Croatia
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Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, Itoh Y, Lieske JC, Seccombe DW, Jones G, Bunk DM, Curhan GC, Narva AS. Current issues in measurement and reporting of urinary albumin excretion. Clin Chem 2008; 55:24-38. [PMID: 19028824 DOI: 10.1373/clinchem.2008.106567] [Citation(s) in RCA: 234] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement. CONTENT The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion. DISCUSSION Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA.
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Afshar R, Sanavi S, Fakharian MA, Ahmadzadeh M. The pattern of proteinuria following karate (Kumite) competitions. NDT Plus 2008; 1:376-7. [PMID: 25983944 PMCID: PMC4421278 DOI: 10.1093/ndtplus/sfn049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tobal D, Olascoaga A, Moreira G, Kurdián M, Sanchez F, Roselló M, Alallón W, Martinez FG, Noboa O. Rust urine after intense hand drumming is caused by extracorpuscular hemolysis. Clin J Am Soc Nephrol 2008; 3:1022-7. [PMID: 18434617 PMCID: PMC2440284 DOI: 10.2215/cjn.04491007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 03/15/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES During Carnival, groups of > or =60 drummers go drumming with their hands and marching for periods of 2 to 4 h. The objective of this study was to determine the frequency and type of urinary abnormalities after candombe drumming and to evaluate possible pathogenic mechanisms. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS For analysis of pathogenic mechanisms, a group of individuals were prospectively evaluated before and after candombe drumming. METHODS Candombe drummers were recruited in January 2006, 1 wk before prolonged drumming. After clinical evaluation, urine and blood samples were obtained before and immediately after drumming. RESULTS Forty-five healthy individuals (four women and 41 men), median age 31 yr (14 to 56), were evaluated. Predrumming urine and plasma samples were obtained for 30 individuals. Nineteen (42%) of 45 had a previous history of rust urine emission temporally related with candombe drumming. After drumming, 18 of 26 showed urine abnormalities; six of 26 showed rust urine, eight of 26 had microhematuria, and seven of 26 had proteinuria >1 g/L. The candombe drummers who showed rust urine after heavy drumming presented significantly higher levels of lactate dehydrogenase and total bilirubin when compared with those without urine abnormalities. Haptoglobin was significantly lower in the rust urine group. Fragmented red cells were observed in the blood smear of individuals with rust urine. Rust urine after drumming was associated with previous episodes of rust urine and glucosuria. CONCLUSIONS Taken together, these data confirm that rust urine is caused by extracorpuscular hemolysis.
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Affiliation(s)
- Diego Tobal
- Centro de Nefrología, Hospital de Clínicas, Facultad de Medicina Universidad de la República, Montevideo, Uruguay
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Koçer G, Şentürk ÜK, Kuru O, Gündüz F. Potential sources of oxidative stress that induce postexercise proteinuria in rats. J Appl Physiol (1985) 2008; 104:1063-8. [DOI: 10.1152/japplphysiol.00581.2007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise-induced proteinuria is a common consequence of physical activity and is caused predominantly by alterations in renal hemodynamics. Although it has been shown that exercise-induced oxidative stress can also contribute to the occurrence of postexercise proteinuria, the sources of reactive oxygen species that promote it are unknown. We investigated the enzymes nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and xanthine oxidase (XO) as possible sources of oxidative stress in postexercise proteinuria. First, we evaluated the effect of blocking the NADPH oxidase enzyme on postexercise proteinuria. We found a significant increase in urinary protein level, kidney thiobarbituric acid-reactive substances (TBARS), and protein carbonyl content after exhaustive exercise, and NADPH oxidase activity was induced by exercise. Rats that were treated with an NADPH oxidase inhibitor for 4 days before exhaustive exercise showed no increase in kidney TBARS or protein carbonyl derivative level and no proteinuria or NADPH oxidase activation. In the next set of experiments, we investigated the effect of XO blockage on postexercise proteinuria. Oxypurinol, an XO inhibitor was administered to rats for 3 days before exercise. Although XO inhibition significantly decreased kidney TBARS levels and protein carbonyl content in exercised rats, the inhibition did not prevent exercise-induced proteinuria. However, plasma and kidney XO activity was not induced by exercise, but rather it was suppressed under oxypurinol treatment. These results suggest that increased NADPH oxidase activity induced by exhaustive exercise is an important source of elevated oxidative, stress during exercise, which contributes to the occurrence of postexercise proteinuria.
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Lamon S, Robinson N, Sottas PE, Henry H, Kamber M, Mangin P, Saugy M. Possible origins of undetectable EPO in urine samples. Clin Chim Acta 2007; 385:61-6. [PMID: 17692836 DOI: 10.1016/j.cca.2007.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to determine the possible origins of undetectable EPO profiles in athletes' urine, we analyzed the data obtained from a large number of official anti-doping urine tests aimed at detecting recombinant erythropoietin. The following variables were considered as potential causes for lack of EPO detection: athlete's gender, competition effect, urine specific gravity as well as possible usage of proteasic adulterants to evade doping detection. RESULTS Statistical analyses indicated that undetectable EPO profiles were clearly related to urine properties such as low EPO concentrations or extreme specific gravities. The addition of very small quantities of protease was shown to remove all traces of EPOs in urine. This finding led to the development of a simple, specific and sensitive test that reveals proteasic activity based on albumin digestion. CONCLUSIONS Urine characteristics clearly affect the detectability of an EPO profile. At the same time, addition of anti-proteases prevents the adulteration of urine. These two findings have clear practical implications with regards to the timing of urine collection as well as the entire anti-doping control procedure.
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Affiliation(s)
- Séverine Lamon
- Laboratoire Suisse d'Analyse du Dopage, Institut Universitaire de Médecine Légale, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Ch. des Croisettes 22, 1066 Epalinges, Switzerland
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Abstract
Urine represents a modified ultrafiltrate of plasma, with protein concentrations typically approximately 1000-fold lower than plasma. Urine’s low protein concentration might suggest it to be a less promising diagnostic specimen than plasma. However, urine can be obtained noninvasively and tests of many urinary proteins are well-established in clinical practice. Proteomic technologies expand opportunities to analyze urinary proteins, identifying more than 1000 proteins and peptides in urine. Urine offers a sampling of most plasma proteins, with increased proportions of low-molecular-weight protein and peptide components. Urine also offers enriched sampling of proteins released along the urinary tract. Although urine presents some challenges as a diagnostic specimen, its diverse range of potential markers offers great potential for diagnosis of both systemic and kidney diseases. Examples of clinical situations where this may be of value are for more sensitive detection of kidney transplant rejection or of renal toxicity of medications.
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Affiliation(s)
- Glen L Hortin
- National Institutes of Health, Department of Laboratory Medicine, Warren Magnuson Clinical Center, Building 10, Room 2C-407, Bethesda, MD 20892-1508, USA.
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