Extreme Ultra-Trail Race Induces Muscular Damage, Risk for Acute Kidney Injury and Hyponatremia: A Case Report

Abstract

A case study involving a healthy trained male athlete who completed a 786 km multi-stage ultra-trail race. Several markers were analyzed in blood and urine samples: creatinine (SCR) for kidney damage, sodium ([Na+]) for hyponatremia, creatine kinase (CK) for exertional rhabdomyolysis, as well as other hematological values. Samples were taken before and after the race and during the recovery period (days 2 and 9 after the race). Results showed: SCR = 1.13 mg/dl, [Na+] =139 mmol/l and CK = 1.099 UI/l. Criteria for the determination of acute kidney damage were not met, and [Na+] concentration was above 135 mEq/L, indicating the absence of hyponatremia. Exertional rhabdomyolysis was suffered by the athlete (baseline CK increased fivefold), though this situation was reverted after 9 days of recovery. Ultra-trail races cause biochemical changes in athletes, which should be known about by healthcare professionals.

768-km Multi-Stage Ultra-Trail Case Study-Muscle Damage, Biochemical Alterations and Strength Loss on Lower Limbs

“…The results obtained in this study coincide with previous research that also shows an elevation in biomarkers of inflammation and muscle damage (CK, LDH, AST and ALT) after the completion of an ultra-trail race [ 6 , 19 , 21 ] and during the recovery period [ 4 ]. CK and LDH have been related to the extreme duration of these races [ 38 , 39 ]; consequently, it could be the cause of fatigue and muscle damage directly or indirectly [ 26 , 40 ].…”

“…On the other hand, the number of stages of the race prevents runners from suffering higher increases in CK and LDH. Multi-stage races may ease the recovery between sections of the event by diminishing the release of muscle damage biomarkers [ 4 , 16 , 43 ]. This disparity in conclusions has generated other biomarkers such as AST and ALT, which are also taken into account for the possible diagnosis of ER.…”

“…These characteristics induce risks in the runner’s health [ 4 ] and have made them become an exceptional model for the evaluation of physiological response to one’s load of effort and stress generated by fatigue [ 5 ]. Acute fatigue induced by physical demand of this type of effort is associated with a relevant modification of biochemical parameters that could result in inaccurate diagnosis [ 6 ].…”

“…Acute fatigue induced by physical demand of this type of effort is associated with a relevant modification of biochemical parameters that could result in inaccurate diagnosis [ 6 ]. The fact that this type of sport discipline requires participants to repeat cyclical movements for very long periods means that episodes of elevation of markers typical of worrying physiological situations have been described, such as acute kidney damage or post-exertion hyponatremia [ 4 , 7 ]. The biochemical alterations should also be taken into account related to myocellular morphological modifications associated with protein breakdown [ 8 ], which in addition to generating a biochemical alteration, causes the loss of contractile function and a decrease in the levels of muscle strength in the runner [ 9 ].…”

Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review

“…Since the turn of the millennium ultra-endurance events, defined by distance (>42.195 km for running), duration (>6 h or multiple days/stages), and environment (mountain, desert) [ 1 , 2 ] have increased in popularity [ 3 , 4 ]. As regular exercise including endurance and/or resistance is recommended to promote health benefits and prolong life [ 5 ], ultra-endurance athletes are considered to be healthy due to their increased cardiovascular fitness, commitment to high-volume training, and increased energy expenditure [ 6 ].…”