“…Our study is the first to suggest that increased renal hypoxia due to high-intensity exercise is a risk factor for RMC. While prior studies have evaluated the clinical characteristics, molecular landscape, and treatment outcomes of RMC, there is little evidence regarding potential modifiable risk factors for RMC [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The exact mechanism linking renal medullary hypoxia to tumorigenesis, and loss of the SMARCB1 tumor suppressor in particular, remains to be determined.…”