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A Case of Exercise-Induced Hematuria Presenting as Gross Hematuria Lasting One Week

1주간 지속된 육안적 혈뇨로 발현한 운동 유발 혈뇨 1예

  • Na, Sun-Young (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Sung, Ji-Yoon (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Jung, Ji-Yong (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Chang, Jae-Hyun (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Kim, Se-Joong (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Chung, Woo-Kyung (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Lee, Hyun-Hee (Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science)
  • 나선영 (가천의과학대학교 길병원 내과학교실) ;
  • 성지윤 (가천의과학대학교 길병원 내과학교실) ;
  • 정지용 (가천의과학대학교 길병원 내과학교실) ;
  • 장제현 (가천의과학대학교 길병원 내과학교실) ;
  • 김세중 (가천의과학대학교 길병원 내과학교실) ;
  • 정우경 (가천의과학대학교 길병원 내과학교실) ;
  • 이현희 (가천의과학대학교 길병원 내과학교실)
  • Published : 2012.01.01

Abstract

Exercise-induced hematuria is a phenomenon occurring in subjects who participate in strenuous exercise. Rapid resolution is an important feature of exercise-induced hematuria. We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. Three months ago, recurrent gross hematuria was lasting 1 week, regardless of exercise intensity. Compression of the left renal vein between the aorta and superior mesenteric artery, without prominent venous collaterals, was detected by computed tomography. However, no abnormalities were detected by renal venography, arteriography or kidney biopsy. Exercise-induced hematuria occurs with a high incidence, but is self-limiting. In contrast, recurrent and gross hematuria can be associated with bladder carcinoma or vascular abnormality. This should be kept in mind, and urological evaluations such as cystoscopy and angiography are necessary in gross and recurrent hematuria.

외래에서 혈뇨 환자를 접하게 되면, 환자의 활동성 및 운동 여부를 반드시 확인하고, 혈뇨가 운동으로 유발되고, 운동 중단 후 호전되는지 확인하여야 한다. 그리고 종양, 감염, 약물, 요석, 신염과 운동 유발 혈뇨를 감별하여, 검사의 진행여부를 결정해야 한다. 하지만 운동 유발 혈뇨가 다른 신장-비뇨기계의 증상 중 하나일 수 있기 때문에 반복적인 혈뇨, 연령 등에 따라 검사가 필요함을 염두해 두어야 한다.

Keywords

References

  1. Feehally J, Floege J, Johnson RJ. Comprehensive Clinical Nephrology. 3rd ed. Philadelphia: Mosby Elsevier, 2007:38: 675-677.
  2. Jones GR, Newhouse I. Sport-related hematuria: a review. Clin J Sport Med 1997;7:119-125. https://doi.org/10.1097/00042752-199704000-00008
  3. Abarbanel J, Benet AE, Lask D, Kimche D. Sports hematuria. J Urol 1990;143:887-890. https://doi.org/10.1016/S0022-5347(17)40125-X
  4. Kallmeyer JC, Miller NM. Urinary changes in ultra longdistance marathon runners. Nephron 1993;64:119-121. https://doi.org/10.1159/000187290
  5. Ubels FL, van Essen GG, de Jong PE, Stegeman CA. Exercise induced macroscopic haematuria: run for a diagnosis? Nephrol Dial Transplant 1999;14:2030-2031. https://doi.org/10.1093/ndt/14.8.2030
  6. Siegel AJ, Hennekens CH, Solomon HS, Van Boeckel B. Exercise-related hematuria: findings in a group of marathon runners. JAMA 1979;241:391-392 https://doi.org/10.1001/jama.1979.03290300033023
  7. Castenfors J. Renal function during prolonged exercise. Ann N Y Acad Sci 1977;301:151-159. https://doi.org/10.1111/j.1749-6632.1977.tb38194.x
  8. Fassett RG, Owen JE, Fairley J, Birch DF, Fairley KF. Urinary red-cell morphology during exercise. Br Med J (Clin Res Ed) 1982;285:1455-1457. https://doi.org/10.1136/bmj.285.6353.1455
  9. Blacklock NJ. Bladder trauma in the long-distance runner: "10,000 metres haematuria". Br J Urol 1977;49:129-132. https://doi.org/10.1111/j.1464-410X.1977.tb04084.x
  10. Mercieri A, Mercieri M, Armanini M, Raiteri M. Exertional haematuria. Lancet 2002;359:1402. https://doi.org/10.1016/S0140-6736(02)08354-X
  11. Patel DR, Torres AD, Greydanus DE. Kidneys and sports. Adolesc Med Clin 2005;16:111-119. https://doi.org/10.1016/j.admecli.2004.09.007
  12. Lüthje P, Nurmi I. Recurrent macroscopic haematuria due to bladder blood vessels after exercise induced haematuria. Br J Sports Med 2004;38:e4. https://doi.org/10.1136/bjsm.2003.007278
  13. Dever DP, Ginsburg ME, Millet DJ, Feinstein MJ, Cockett AT. Nutcracker phenomenon. Urology 1986;27:540-542. https://doi.org/10.1016/0090-4295(86)90337-7
  14. Buschi AJ, Harrison RB, Norman A, et al. Distended left renal vein: CT/sonographic normal variant. AJR Am J Roentgenol 1980;135:339-342. https://doi.org/10.2214/ajr.135.2.339
  15. Romera-Villegas A, Vila-Coll R, Cairols-Castellote M, Poveda-Monge R, Masuet-Aumatell C, Grinyo-Boira M. The importance of a standing position in the diagnosis of Nutcracker phenomenon by duplex sonography. Int Angiol 2009;28:461-468.