Kidney Injury and Repair Biomarkers in Marathon Runners

Sherry G. Mansour, Gagan Verma, Rachel W. Pata, Thomas G. Martin, Mark A. Perazella, Chirag Parikh

Research output: Contribution to journalArticle

Abstract

Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study. Setting & Participants Runners participating in the 2015 Hartford Marathon. Predictor Completing a marathon. Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours premarathon (day 0), immediately postmarathon (day 1), and 24 hours postmarathon (day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed, as well as urine microscopy analysis. 6 injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and 2 repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41% were men. 82% of runners developed an increase in creatinine level equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to significantly increase from day 0 to day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediment diagnostic of tubular injury. An increase in injury and repair biomarker levels suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

Original languageEnglish (US)
Pages (from-to)252-261
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number2
DOIs
StatePublished - Aug 1 2017

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Acute Kidney Injury
Biomarkers
Urine
Creatinine
Kidney
Wounds and Injuries
Microscopy
Creatine Kinase
Serum
Albumins
Interleukin-18
Chemokine CCL2
Interleukin-8
Sample Size
Observational Studies
Interleukin-6
Tumor Necrosis Factor-alpha
Epithelial Cells
Prospective Studies

Keywords

  • Acute kidney injury (AKI)
  • acute tubular injury
  • creatine kinase
  • injury biomarkers
  • marathon running
  • renal damage
  • repair biomarkers
  • serum creatinine
  • strenuous exercise
  • tubular injury
  • urine albumin
  • urine microscopy

ASJC Scopus subject areas

  • Nephrology

Cite this

Mansour, S. G., Verma, G., Pata, R. W., Martin, T. G., Perazella, M. A., & Parikh, C. (2017). Kidney Injury and Repair Biomarkers in Marathon Runners. American Journal of Kidney Diseases, 70(2), 252-261. https://doi.org/10.1053/j.ajkd.2017.01.045

Kidney Injury and Repair Biomarkers in Marathon Runners. / Mansour, Sherry G.; Verma, Gagan; Pata, Rachel W.; Martin, Thomas G.; Perazella, Mark A.; Parikh, Chirag.

In: American Journal of Kidney Diseases, Vol. 70, No. 2, 01.08.2017, p. 252-261.

Research output: Contribution to journalArticle

Mansour, SG, Verma, G, Pata, RW, Martin, TG, Perazella, MA & Parikh, C 2017, 'Kidney Injury and Repair Biomarkers in Marathon Runners', American Journal of Kidney Diseases, vol. 70, no. 2, pp. 252-261. https://doi.org/10.1053/j.ajkd.2017.01.045
Mansour, Sherry G. ; Verma, Gagan ; Pata, Rachel W. ; Martin, Thomas G. ; Perazella, Mark A. ; Parikh, Chirag. / Kidney Injury and Repair Biomarkers in Marathon Runners. In: American Journal of Kidney Diseases. 2017 ; Vol. 70, No. 2. pp. 252-261.
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abstract = "Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study. Setting & Participants Runners participating in the 2015 Hartford Marathon. Predictor Completing a marathon. Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours premarathon (day 0), immediately postmarathon (day 1), and 24 hours postmarathon (day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed, as well as urine microscopy analysis. 6 injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and 2 repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41{\%} were men. 82{\%} of runners developed an increase in creatinine level equivalent to AKIN-defined AKI stages 1 and 2. 73{\%} had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to significantly increase from day 0 to day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediment diagnostic of tubular injury. An increase in injury and repair biomarker levels suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.",
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N2 - Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study. Setting & Participants Runners participating in the 2015 Hartford Marathon. Predictor Completing a marathon. Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours premarathon (day 0), immediately postmarathon (day 1), and 24 hours postmarathon (day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed, as well as urine microscopy analysis. 6 injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and 2 repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41% were men. 82% of runners developed an increase in creatinine level equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to significantly increase from day 0 to day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediment diagnostic of tubular injury. An increase in injury and repair biomarker levels suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

AB - Background Investigation into strenuous activity and kidney function has gained interest given increasing marathon participation. Study Design Prospective observational study. Setting & Participants Runners participating in the 2015 Hartford Marathon. Predictor Completing a marathon. Outcomes Acute kidney injury (AKI) as defined by AKI Network (AKIN) criteria. Stage 1 AKI was defined as 1.5- to 2-fold or 0.3-mg/dL increase in serum creatinine level within 48 hours of day 0 and stage 2 was defined as a more than 2- to 3-fold increase in creatinine level. Microscopy score was defined by the number of granular casts and renal tubular epithelial cells. Measurements Samples were collected 24 hours premarathon (day 0), immediately postmarathon (day 1), and 24 hours postmarathon (day 2). Measurements of serum creatinine, creatine kinase, and urine albumin were completed, as well as urine microscopy analysis. 6 injury urine biomarkers (IL-6, IL-8, IL-18, kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, and tumor necrosis factor α) and 2 repair urine biomarkers (YKL-40 and monocyte chemoattractant protein 1) were measured. Results 22 marathon runners were included. Mean age was 44 years and 41% were men. 82% of runners developed an increase in creatinine level equivalent to AKIN-defined AKI stages 1 and 2. 73% had microscopy diagnoses of tubular injury. Serum creatinine, urine albumin, and injury and repair biomarker levels peaked on day 1 and were significantly elevated compared to day 0 and day 2. Serum creatine kinase levels continued to significantly increase from day 0 to day 2. Limitations Small sample size and limited clinical data available at all time points. Conclusions Marathon runners developed AKI and urine sediment diagnostic of tubular injury. An increase in injury and repair biomarker levels suggests structural damage to renal tubules occurring after marathon. The results of our study should be validated in larger cohorts with longer follow-up of kidney function.

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