Acute renal failure (ARF) with severe loin
pain induced by anaerobic exercise is a rare condition that is accompanied by wedge-shaped contrast enhancement seen on computerized tomographic (CT) scan without evidence of
rhabdomyolysis. An 18-year-old Korean male was transferred to our hospital for evaluation of mild
azotemia, that developed after anaerobic exercise. The laboratory tests revealed that the serum
creatinine was 2.1 mg/dl and the serum
uric acid level was 1.6 mg/dl without any elevation of the serum
myoglobin or
creatine phosphokinase. Under the impression of exercise-induced ARF, we tried to determine the relationship between the occurrence of clinical symptoms, renal dysfunction and the characteristic CT findings by observing those changes prospectively before and after anaerobic exercise. After obtaining a written consent, the patient underwent a strenuous period of anaerobic exercise to induce the clinical symptoms. Before exercise, he was completely asymptomatic; his serum
creatinine level was 0.9 mg/dl and CT scan of the kidneys showed no abnormalities. Loin
pain developed 2 hours after exercise, and the serum
creatinine level increased to 1.2 mg/dl 18 hours after the exercise. CT scan 18 hours after exercise showed multiple perfusion defects, and a 24-hour delayed CT scan showed multiple areas of wedge-shaped enhancement on both kidneys. These changes were completely resolved on the follow-up CT scan obtained 13 days after exercise with the return of a normal serum
creatinine level. We conclude that reversible renal vasoconstriction is probably the main pathophysiologic mechanism of
acute renal failure induced by anaerobic exercise.