Transient proteinuria in children can be idiopathic or secondary to exercise or fever. Exercise related proteinuria usually is derived from low renal blood flow to the kidneys. It usually is defined as urinary protein excretion higher than 100-150 mg/m2/day and ends 24 hours after exercise. The intensity of exercise has a main role in the amount of protein excreting in the urine. It usually is transient. However, further assessment is needed to exclude systemic diseases if proteinuria is present besides hematuria, if it does not disappear after 48 hours, or if more than 1 gram of protein is excreted from the urine in a day.
Keywords: Proteinuria; Exercise; Child.
Vehaskari, V.M. and J. Rapola, Isolated proteinuria: analysis of a school-age population. The Journal of pediatrics, 1982. 101(5): p. 661-668.
Bellinghieri, G., V. Savica, and D. Santoro, Renal alterations during exercise. Journal of Renal Nutrition, 2008. 18(1): p. 158-164.
Dudley, J., et al., Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch-Schönlein Purpura (HSP). Archives of disease in childhood, 2013. 98(10): p. 756-763.
Bergstein, J.M., A practical approach to proteinuria. Pediatric Nephrology, 1999. 13(8): p. 697-700.
Jang, K.M. and M.H. Cho, Clinical Approach to Children with Proteinuria. Childhood Kidney Diseases, 2017. 21(2): p. 53-60.
Chang-Chien, C., et al., A large retrospective review of persistent proteinuria in children. Journal of the Formosan Medical Association, 2018. 117(8): p. 711-719.
Hogg, R.J., et al., Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics, 2000. 105(6): p. 1242-1249.
Dale-Shall, A.W. and L.G. Feld, Approach to the Child with Proteinuria. Textbook of Clinical Pediatrics, 2012: p. 2711-2721.
Leung, A.K., A.H. Wong, and S.S. Barg, Proteinuria in Children: Evaluation and Differential Diagnosis. American family physician, 2017. 95(4).
Coye, R.D. and R.R. Rosandich, Proteinuria during the 24-hour period following exercise. Journal of applied physiology, 1960. 15(4): p. 592-594.
Poortmans, J.R., Postexercise proteinuria in humans: facts and mechanisms. Jama, 1985. 253(2): p. 236-240.
Poortmans, J., et al., Urine protein excretion and swimming events. Medicine and science in sports and exercise, 1991. 23(7): p. 831-835.
Epstein, J.B. and E.J. Zambraski, Proteinuria in the exercising dog. Medicine and science in sports, 1979. 11(4): p. 348-350.
Kohanpour, M.-A., et al., Effect of submaximal aerobic exercise in hypoxic conditions on proteinuria and hematuria in physically trained young men. Iranian journal of kidney diseases, 2012. 6(3): p. 192.
Montelpare, W., P. Klentrou, and J. Thoden, Continuous versus intermittent exercise effects on urinary excretion of albumin and total protein. Journal of science and medicine in sport, 2002. 5(3): p. 219-228.
Shephard, R.J., Exercise proteinuria and hematuria: current knowledge and future directions. The Journal of sports medicine and physical fitness, 2016. 56(9): p. 1060-1076.
Von Leube, W., Über ausscheidung von Eiweiss in harn des gesunden menschen. Virkows Arch Pathol Anat Physiol, 1878. 72: p. 145-147.
Light, A.B. and C.R. Warren, Urea clearance and proteinuria during exercise. American Journal of Physiology-Legacy Content, 1936. 117(4): p. 658-661.
Huttunen, N.-P., et al., Exercise-induced proteinuria in children and adolescents. Scandinavian journal of clinical and laboratory investigation, 1981. 41(6): p. 583-587.
Mogensen, C. and E. Vittinghus, Urinary albumin excretion during exercise in juvenile diabetes a provocation test for early abnormalities. Scandinavian journal of clinical and laboratory investigation, 1975. 35(4): p. 295-300.
Viberti, G., et al., Increased glomerular permeability to albumin induced by exercise in diabetic subjects. Diabetologia, 1978. 14(5): p. 293-300.
Poortmans, J.R. and J. Vanderstraeten, Kidney function during exercise in healthy and diseased humans. Sports Medicine, 1994. 18(6): p. 419-437.
Ward, K.M., J.D. Mahan, and W.M. Sherman, Aerobic training and diabetic nephropathy in the obese Zucker rat. Annals of Clinical & Laboratory Science, 1994. 24(3): p. 266-277.
Ito, D., et al., Chronic running exercise alleviates early progression of nephropathy with upregulation of nitric oxide synthases and suppression of glycation in zucker diabetic rats. PLoS One, 2015. 10(9): p. e0138037.
Tufescu, A., et al., Combination of exercise and losartan enhances renoprotective and peripheral effects in spontaneously type 2 diabetes mellitus rats with nephropathy. Journal of hypertension, 2008. 26(2): p. 312-321.
Rodrigues, A.M., et al., Effects of training and nitric oxide on diabetic nephropathy progression in type I diabetic rats. Experimental Biology and Medicine, 2011. 236(10): p. 1180-1187.
Cantone, A. and P. Cerretelli, Effect of training on proteinuria following muscular exercise. Internationale Zeitschrift für angewandte Physiologie einschließlich Arbeitsphysiologie, 1960. 18(4): p. 324-329.
Wadén, J., et al., Leisure-time physical activity and development and progression of diabetic nephropathy in type 1 diabetes: the FinnDiane Study. Diabetologia, 2015. 58(5): p. 929-936.
Wadén, J., et al., Physical activity and diabetes complications in patients with type 1 diabetes: the Finnish Diabetic Nephropathy (FinnDiane) Study. Diabetes care, 2008. 31(2): p. 230-232.
Huynh, A., et al., Outcomes of exertional rhabdomyolysis following high‐intensity resistance training. Internal medicine journal, 2016. 46(5): p. 602-608.
Spada, T.C., et al., High intensity resistance training causes muscle damage and increases biomarkers of acute kidney injury in healthy individuals. PloS one, 2018. 13(11): p. e0205791.
Kellum, J.A., et al., Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney international supplements, 2012. 2(1): p. 1-138.
Huttunen, N.-P., et al., Exercise-induced proteinuria in children and adolescents with type 1 (insulin dependent) diabetes. Diabetologia, 1981. 21(5): p. 495-497.
Koivisto, V., N. Huttunen, and P. Vierikko, Continuous subcutaneous insulin infusion corrects exercise-induced albuminuria in juvenile diabetes. British medical journal (Clinical research ed.), 1981. 282(6266): p. 778.
Dahlquist, G., et al., Effect of metabolic control and duration on exercise‐induced albuminuria in diabetic teen‐agers. Acta Pædiatrica, 1983. 72(6): p. 895-902.
Mostafa, M.S., et al., Effect of Exercise on Urinary Excretion of Some Indicators of Diabetic Nephropathy in Type I Diabetic Children. Bull. Fac. Ph. Th. Cairo Univ, 2007. 12(2).
Poortmans, J., H. Dorchy, and D. Toussaint, Urinary excretion of total proteins, albumin, and β2-microglobulin during rest and exercise in diabetic adolescents with and without retinopathy. Diabetes Care, 1982. 5(6): p. 617-623.
Hermansson, G. and J. Ludvigsson, Renal function and blood‐pressure reaction during exercise in diabetic and non‐diabetic children and adolescents: A pilot study. Acta Pediatrica, 1980. 69: p. 86-94.
Johansson, B.-L., et al., Exercise-induced changes in renal function and their relation to plasma noradrenaline in insulin-dependent diabetic children and adolescents. Clinical Science, 1987. 72(5): p. 611-620.
Lane, J.T., et al., Acute effects of different intensities of exercise in normoalbuminuric/normotensive patients with type 1 diabetes. Diabetes Care, 2004. 27(1): p. 28-32.
Christensen, C.K., Abnormal albuminuria and blood pressure rise in incipient diabetic nephropathy induced by exercise. Kidney international, 1984. 25(5): p. 819-823.
Kornhauser, C., et al., Effect of exercise intensity on albuminuria in adolescents with Type 1 diabetes mellitus. Diabetic Medicine, 2012. 29(1): p. 70-73.
Chimen, M., et al., What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia, 2012. 55(3): p. 542-551.
Peirce, N., Diabetes and exercise. British journal of sports medicine, 1999. 33(3): p. 161-172.
Dahlquist, G., E.L. Stattin, and S. Rudberg, Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long‐term follow‐up study of childhood onset type‐1 diabetic patients. Nephrology Dialysis Transplantation, 2001. 16(7): p. 1382-1386.
Garg, S.K., et al., Glycemic control and longitudinal testing for exercise microalbuminuria in subjects with Type I diabetes. Journal of Diabetic Complications, 1990. 4(4): p. 154-158.
O'Brien, S.F., et al., Exercise testing as a long-term predictor of the development of microalbuminuria in normoalbuminuric IDDM patients. Diabetes Care, 1995. 18(12): p. 1602-1605.
Bognetti, E., et al., Post‐exercise Albuminuria Does Not Predict Microalbuminuria in Type 1 Diabetic Pantients. Diabetic medicine, 1994. 11(9): p. 850-855.
Elving, L., et al., Exercise-induced albuminuria in normoalbuminuric insulin-dependent diabetic patients. PDF hosted at the Radboud Repository of the Radboud University Nijmegen, 1995: p. 39.
Dash, R. and O. Torffvit, How to predict nephropathy in type 1 diabetic patients Routine data or provocation by exercise testing? Scandinavian journal of urology and nephrology, 2003. 37(5): p. 437-442.
Koh, K., B. Dayanath, and J. Doery, The effect of exercise on urine albuminuria excretion in diabetic subjects. Nephrology (Carlton), 2011. 16: p. 704-709.
Khan, I., et al., Renal excretory response at high altitude. Journal of Postgraduate Medical Institute (Peshawar-Pakistan), 2011. 12(1).
Poortmans, J., et al., Postexercise proteinuria in childhood and adolescence. International journal of sports medicine, 1996. 17(06): p. 448-451.
Rayner B, schwellnus M. Exercise and the Kidney. In:Schwellnus M. Olympic Textbook of Medicine in Sport, International Olympic Committee, 2008,375-389.
Luciani G, Giungi M, Di Mugno M. Rene e sport. Urologia, 2010;77(2):107-111.
Hoffmann MD, Stuempfle KJ, Fogard K, Hew-Butler T, Winger J, Weiss RH. Urine dipstick analysis for identification of runners susceptible to acute kidney injury following an ultramarathon. J Sports Sci 2013; 31(1):20-31. doi:10.1080/02640414.2012.720705.