Saturday, August 17, 2019
Reversible acute kidney disease in a ultrarunner
Reversible Kidney Damage in a 100 mile runner.
At the 2018 Western States 100 mile race we encountered a
runner who presented to the medical aid station at mile 70. The runner was on his goal pace but had been
noticing that the color of his urine had changed from clear to “copper
colored.” He denied any severe muscle pain and was
running well. This urine color began
changing around mile 30 and then fluctuated for a while before getting worse
between mile 65-70. He also had not had
any nausea or vomiting during the race.
He had taken some non-steroidal anti-inflammatories around mile 62 for foot and ankle pain he had for about 40
miles. . He was well ahead of the cutoff at the aid
station.
Because of his symptoms, we elected to do an I-stat on a
venous sample.
Results showed:
Sodium 135 (138-146)
Potassium 6.2
(3.5-4.9)
Chloride 98 (98-109)
CO2 27 (24-29)
Bun 58 (8-26)
Creatinine 2.2
(0.6-1.3)
Glucose 127 (70-105)
After consultation with the race director, we discussed the
risks of him continuing and warning signs.
He was instructed to back off his pace a bit, hydrate and not take any
more anti-inflammatories. He was also instructed to recheck in at the
medical tent at the finish for re-evaluation.
He “fast-walked” with
some mild running from mile 70-95. At
mile 95 he started running again with no problems. Upon finishing, we performed another i-stat.
Post race results showed
Sodium 134
Potassium 4.8
Chloride 100
CO2 23
BUN 44
Creatinine 1.6
Glucose 123
This is the first time we have seen a runner with acute
renal injury as documented by i-stat testing continue with a race and show
improvement in renal function while continuing with the race. The treatment plan of increasing hydration,
backing off of exertion and avoiding NSAIDS allowed him to finish while his
renal function improved. Despite the elevated BUN/Cr levels, the runner
was looking good and didn’t seem in any medical distress.
Teaching points:
1) Runners with mild renal failure can continue to safely
run a race given proper instructions
2) Having an i-stat available did give us the ability to more accurately
determine the extent of the runners kidney injury
3) In cases where there are no clear guidelines,
having an honest discussion with athletes
of the risk/benefits of continuing the race can help the runner meet their
goals. In this case, we were fortunate
that the runner was honest with the medical staff and trusted our advice. In return, we also wanted to do what we could
to help the runner continue so they could achieve a race finish.
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