Exercise and the Kidney in Diabetes

  • Carl Erik Mogensen


Exercise proteinuria has been known in many years. There are early descriptions of the phenomenon, but the first published reports of exercise-induced albuminuria is given by Collier in 1907, describing »functional albuminuria« in athletes [1]. Since then many papers on this topic related to normal renal physiology have been published [2–19]. The first to describe comprehensively haemodynamic effect of exercise in diabetes was the Swedish investigator T. Karlefors. He studied exercise tests in male diabetics and looked for instance at heart rate and systolic blood pressure raises [20]. A new era started around 1970 after the introduction of exact measurement of urinary albumin excretion rate, for instance by radioimmunoassay or other immuno-based techniques [21,22].


Blood Pressure Response Albumin Excretion Rate Filtration Fraction Urinary Albumin Excretion Rate Overt Nephropathy 
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  1. 1.
    Collier W. Functional albuminuria in athletes. BMJ 1907; 1:4–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Campanacci L, Faccini L, Englaro E, Rustía R, Guamieri GF, Barat R, Carraro M, De Zotti R, Micheli W. Exercise-induced proteinuria. Contr Nephrol 1981; 26:31–41.Google Scholar
  3. 3.
    Castenfors J. Renal function during exercise. With special reference to exercise proteinuria and the release of renin. Acta Physiol Scand 1967; 70: Suppl. 293.CrossRefGoogle Scholar
  4. 4.
    Clerico A, Giammattei C, Cecchini I., Lucchetti A, Cruschelli L, Penno G, Gregori G, Giampietro O. Exercise-induced proteinuria in well-trained athletes. Clin Chem 1990; 36: 562–564.PubMedGoogle Scholar
  5. 5.
    Houser MT, Jahn MF, Kobayashi A, Walbum J. Assessment of urinary protein excretion in the adolescent: Effect of body position and exercise. J Pediatr 1986; 109:556–561.PubMedCrossRefGoogle Scholar
  6. 6.
    Houser MT. Characterization of recumbent, ambulatory, and postexercise proteinuria in the adolescent Pediatr Res 1987; 21: 442–446.PubMedCrossRefGoogle Scholar
  7. 7.
    Huttunen N-P, Käär M-L, Pietiläinen M, Vierikko P, Reinilä M. Exercise-induced proteinuria in children and adolescents. Scand J Clin Lab Invest 1981; 41: 583–587.PubMedCrossRefGoogle Scholar
  8. 8.
    Kachadorian WA, Johnson RE. Renal responses to various rates of exercise. J Appl Physiol 1970; 28: 748–752.PubMedGoogle Scholar
  9. 9.
    Krämer BK, Kernz M, Ress KM, Pfohi M, Müller GA, Schmülling R-M, Risler T. Influence of strenuous exercise on albumin excretion Clin Chem 1988; 34: 2516–2518.PubMedGoogle Scholar
  10. 10.
    Mogensen CE, Vittinghus E, Soiling E. Abnormal albumin excretion after two provocative renal tests in diabetes: Physical exercise and lysine injection. Kidney hit 1979; 16:385–393.CrossRefGoogle Scholar
  11. 11.
    Mogensen CE, Vittinghus E. Urinary albumin excretion during exercise in juvenile diabetes. A provocative test for early abnormalities. Scand J Clin Lab Invest 1975; 35:295–300.PubMedCrossRefGoogle Scholar
  12. 12.
    Mohamed A, Wilkin T, Leatherdale BA, Rowe D. Response of urinary albumin to submaximal exercise in newly diagnosed non-insulin dependent diabetes. BMJ 1984; 288:1342–1343.PubMedCrossRefGoogle Scholar
  13. 13.
    Nordgren H, Freyschuss U, Persson B. Blood pressure response to physical exercise in healthy adolescents and adolescents with insulin-dependent diabetes mellitus. Clin Sci 1994; 86: 425–432.PubMedGoogle Scholar
  14. 14.
    Osei K. Ambulatory and exercise-induced blood pressure responses in type I diabetic patients and normal subjects. Diabetes Res Clin Pract 1987; 3:125–134.PubMedCrossRefGoogle Scholar
  15. 15.
    Pedersen EB, Mogensen CE, Larsen JS. Effects of exercise on urinary excretion of albumin and beta-2-microgIobulin in young patients with mild essential hypertension without treatment and during long-term propranolol treatment Scand J Clin Lab Invest 1981; 41:493–498.PubMedCrossRefGoogle Scholar
  16. 16.
    Poortmans J, Dorchy H, Toussaint D. Urinary excretion of total proteins, albumin, and β2-microglobulin during rest and exercise in diabetic adolescents with and without retinopathy. Diabetes Care 1982; 5:617–623.PubMedCrossRefGoogle Scholar
  17. 17.
    Poortmans JR. Postexercise proteinuria in humans. Facts and mechanisms. JAMA 1985; 253: 236–240.PubMedCrossRefGoogle Scholar
  18. 18.
    Robertshaw M, Cheung CK, Fairly I, Swaminathan R. Protein excretion after prolonged exercise. Arm Clin Biochem 1993; 30:34–37.Google Scholar
  19. 19.
    Taylor A. Some characteristics of exercise proteinuria. Clin Sci 1960; 19:209–217.PubMedGoogle Scholar
  20. 19a.
    Torffvit O, Castenfors J, Bengjlsson U, Agardh CD. Exercise stimulation in insulin-dependent diabetics, normal increase in albuminuria with abnormal blood pressure response. Scand J Clin Lab Invest 1987; 47:253–259.PubMedCrossRefGoogle Scholar
  21. 20.
    Karlefors T. Circulatory studies during exercise with particular reference to diabetics. Acta Med Scand 1966; 180: Suppl. 449.Google Scholar
  22. 21.
    Keen H, Ghlouverakis C. Urinary albumin excretion and diabetes mellitus. Lancet 1964; ii: 1155–1156.CrossRefGoogle Scholar
  23. 22.
    Miles DW, Mogensen CE, Gundersen HJG. Radioimmunoassay for urinary albumin using a single antibody. Scand J Clin Lab Invest 1970; 26: 5–11.PubMedCrossRefGoogle Scholar
  24. 23.
    Mogensen CE, Vestbo E, Poulsen PL, Christiansen C, Damsgaard EM, Eiskjaer H, Freland A, Hansen KW, Nielsen S, Mau Pedersen M Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion. Diabetes Care 1995; 18: 572–581.PubMedGoogle Scholar
  25. 24.
    Mogensen CE. Microalbuminuria, early blood pressure elevation, and diabetic renal disease. Current Opinion in Endocrinology and Diabetes 1994; 1:239–247.CrossRefGoogle Scholar
  26. 25.
    Christensen CK, Krusell LR. Acute and long-term effect of antihypertensive treatment on exercise induced microalbuminuria in essential hypertension. J Clin Hypertension 1987; 3: 704–712.Google Scholar
  27. 26.
    Christensen CK, Mogensen CE. Acute and long-term effect of antihypertensive treatment on exercise-induced albuminuria in incipient diabetic nephropathy. Scand J Clin Lab Invest 1986; 46: 553–559.PubMedCrossRefGoogle Scholar
  28. 27.
    Romanelli G, Giustina A, Bossoni S, Caldonaxxo A, Cimino A, Cravarezza P, Giustina G. Short-term administration of Captopril and nifedipine and exercise-induced albuminuria in normotensive diabetic patients with early-stage nephropathy. Diabetes 1990; 39:1333–1338.PubMedCrossRefGoogle Scholar
  29. 28.
    Romanelli G, Giustina A, Cimino A. Short term effect of Captopril on microalbuminuria induced by exercise in normotensive diabetics. BMJ 1989; 298:284–288.PubMedCrossRefGoogle Scholar
  30. 29.
    Rângemark C, Lind H, Lindholm L, Hedner T, Samuelsson O. Lisinopril reduces postexercise albuminuria more effectively than atenolol in primary hypertension. Eur J Clin Pharmacol 1996; 49: 267–271.PubMedCrossRefGoogle Scholar
  31. 30.
    Christensen CK. Abnormal albuminuria and blood pressure rise in incipient diabetic nephropathy induced by exercise. Kidney Int 1984; 25: 819–823.PubMedCrossRefGoogle Scholar
  32. 31.
    Vittinghus E, Mogensen CE. Graded exercise and protein excretion in diabetic man and the effect of insulin treatment. Kidney Int 1982; 21: 725–729.PubMedCrossRefGoogle Scholar
  33. 32.
    Vittinghus E, Mogensen CE. Albumin excretion and renal haemodynamic response to physical exercise in normal and diabetic man. Scand J Clin Lab Invest 1981; 41: 627–632.PubMedCrossRefGoogle Scholar
  34. 33.
    Ala-Houhala I. Effects of exercise on glomerular passage of macromolecules in patients with diabetic nephropathy and in healthy subjects. Scand J Clin Lab Invest 1990; 50:27–33.PubMedCrossRefGoogle Scholar
  35. 34.
    Brouhard BH, Allen K, Sapire D, Travis LB. Effect of exercise on urinary N-acetyl-beta-D-glucosaminidase activity and albumin excretion in children with type I diabetes mellitus. Diabetes Care 1985; 8:466–472.PubMedCrossRefGoogle Scholar
  36. 35.
    Chase HP, Garg SK, Harris S, Marshall G, Hoops S. Elevation of resting and exercise blood pressures in subjects with type I diabetes and relation to albuminuria. J Diabetic Compl 1992; 6: 138–142.CrossRefGoogle Scholar
  37. 36.
    Feldt-Rasmussen B, Baker L, Deckert T. Exercise as a provocative test in early renal disease in Type 1 (insulin-dependent) diabetes: albuminuric, systemic and renal haemodynamic responses. Diabetologia 1985; 28:389–396.PubMedCrossRefGoogle Scholar
  38. 37.
    Garg SK, Chase HP, Harris S, Marshall G, Hoops S, Osberg L Glycemic control and longitudinal testing for exercise microalbuminuria in subjects with type I diabetes. J Diabetic Compl 1990; 4:154–158.CrossRefGoogle Scholar
  39. 38.
    Groop L, Stenman S, Groop PH, Makipernaa A, Teppo AM The effect of exercise on urinary excretion of different size proteins in patients with insulin-dependent diabetes mellitus. Scand J Clin Lab Invest 1990; 50: 525–532.PubMedCrossRefGoogle Scholar
  40. 39.
    Hermansson G, Ludvigsson J. Renal function and blood-pressure reaction during exercise in diabetic and non-diabetic children and adolescents. Acta Paediatr Scand 1980;Suppl. 283:89–94.Google Scholar
  41. 40.
    Hopper AH, Tindall H, Urquhart S, Davies JA, Reduction of exercise-induced albuminuria by aspirin-dipyridamole in patients with diabetes mellitus. Horm Metab Res 1987; 19: 210–213.CrossRefGoogle Scholar
  42. 41.
    Huttunen N-P, Käär M-L. Puukka R, Åkerblom HK. Exercise-induced proteinuria in children and adolescents with type 1 (insulin dependent) diabetes. Diabetologia 1981; 21: 495–497.PubMedCrossRefGoogle Scholar
  43. 42.
    Jefferson JG, Greene SA, Smith MA, Smith RF, Griffin NKG, Baum JD. Urine albumin to creatinine ratio response to exercise in diabetes. Arch Dis Child 1985; 60: 305.PubMedCrossRefGoogle Scholar
  44. 43.
    Koivisto VA, Huttunen N-P, Vierikko P. Continuous subcutaneous insulin infusion corrects exercise-induced albuminuria in juvenile diabetes. BMJ 1981; 282: 778–779.PubMedCrossRefGoogle Scholar
  45. 44.
    Rubier S, Arvan SB. Exercise testing in young asymptomatic diabetic patients. Angiology 1976; 27: 539–548.CrossRefGoogle Scholar
  46. 45.
    Mogensen CE. Renal function changes in diabetes. Diabetes 1976; 25: suppl. 2: 872–879.Google Scholar
  47. 46.
    Townsend JC. Increased albumin excretion in diabetes. J Clin Path 1990; 43:3–8.PubMedCrossRefGoogle Scholar
  48. 47.
    Viberti GC, Jarrett RJ, McCartney M, Keen M. Increased glomerular permeability to albumin induced by exercise in diabetic subjects. Diabetologia 1978; 14: 293–300.PubMedCrossRefGoogle Scholar
  49. 48.
    Viberti GC, Pickup JC, Bilous RW, Keen H, Mackintosh D. Correction of exercise-induced microalbuminuria in insulin-dependent diabetics after 3 weeks of subcutaneous insulin infusion. Diabetes 1981; 30: 818–823.PubMedCrossRefGoogle Scholar
  50. 49.
    Watts GF, Williams I, Morris RW, Mandalia S, Shaw KM, Polak A. An acceptable exercise test to study microalbuminuria in Type 1 diabetes. Diabetic Med 1989; 6:787–792.PubMedCrossRefGoogle Scholar
  51. 50.
    Dahlquist G, Aperia A, Carlsson L, Linne T, Persson B, Thoren C, Wilton P. Effect of metabolic control and duration on exercise-induced albuminuria in diabetic teen-agers. Acta Paediatr Scand 1983; 72: 895–902.PubMedCrossRefGoogle Scholar
  52. 51.
    Fujita Y, Matoba K, Takeuchi H, Ishii K, Yajima Y. Anaerobic threshold can provoke microalbuminuria in non-insulin-dependent diabetics. Diabetes Res Clin Pract 1994; 22: 155–162.PubMedCrossRefGoogle Scholar
  53. 52.
    Inomata S, Oosawa Y, Itoh M, Inoue M, Masamune O. Analysis of urinary proteins in diabetes mellitus — with reference to the relationship between microalbuminuria and diabetic renal lesions. J Japan Diabetic Soc 1987; 30:429–435.Google Scholar
  54. 53.
    O’Brien SF, Watts GF, Powrie JK, Shaw KM Exercise testing as a long-term predictor of the development of microalbuminuria in normoalbuminuric IDDM patients. Diabetes Care 1995; 18: 1602–1605.PubMedCrossRefGoogle Scholar
  55. 54.
    Matsuoka K, Nakao T, Atsumi Y, Takekoshi H. Exercise regimen for patients with diabetic nephropathy. J Diabetic Compl 1991; 5:98–100.CrossRefGoogle Scholar
  56. 55.
    Giustina A, Perini P, Desenzani P, Bossoni S, Ianniello P, Milani M, Davi G, Romanelli G. Long-term treatment with the dual antithromboxane agent piootamide decreases microalbuminuria in normotensivetype 2 diabetic patients. Diabetes 47: 423–430, 1998PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Carl Erik Mogensen
    • 1
  1. 1.Medical Department MAarhus KommunehospitalAarhusDenmark

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