Exercise-Induced Acute Renal Failure (ALPE)

Abstract

The first patient to be recognized as having this condition was a 29-year-old man [1]. On August 20, 1979, he attended an emergency outpatient unit at night with severe loin pain. His serum creatinine level was slightly increased (1.6 mg/dl). Under a tentative diagnosis of ureteral stone, an intravenous pyelography (IVP) was performed. However, there was no stone. Plain computed tomography (CT) 22 hafter the administration of a contrast medium (delayed CT: plain CT several hours or days after the administration of a contrast medium) (Fig. 2) showed patchy wedge-shaped contrast enhancement in the bilateral kidneys (the first image in a human). This persisted for 48 h after administration of the medium (Fig. 3) [1]. A kidney biopsy 2 weeks after onset suggested acute tubular necrosis (Fig. 4). At the same time, we were conducting an experiment involving an infusion of microspheres into a rat heart and glomerular supervital staining with Alcian blue, and we found some wedge-shaped lesions. As this finding suggested renal infarction (Fig. 5), we speculated that the wedge-shaped contrast enhancement in our patient was associated with a vascular lesion (vasoconstriction).