March hemoglobinuria

March hemoglobinuria, also known as march hematuria, occurs when blood is seen in the urine after repetitive impacts on the body, particularly affecting the feet (such as running on a hard road or Kendo) and hands (e.g. Conga or Candombe drumming).^[1] The word "march" is in reference to the condition arising in soldiers who have been marching for long periods; the condition was first documented in 1881.^[2]

Cause

The repetitive nature of these types of activities cause mechanical trauma to the red blood cells causing hemolysis. Free haemoglobin released from lysed red blood cells is filtered into the urine. Defects in red blood cell membrane proteins have been identified in some of these patients.^[3]. The dead RBC's are filtered by the glomerulus and are removed from the body. Due to destruction of a large number of RBC's, a large number of damaged blood cells are filtered out of the body at the same time, making the urine have noticeable amounts of hemoglobin in solution.

Prognosis

The situation usually lasts for a day or two. No specific medication is required. This condition usually goes unnoticed, except by those with a history of hematuria. March haemoglobinuria is usually not life threatening.

Relation to athletic nephritis

Hematuria after strenuous exercise may also result from athletic nephritis, which is a kidney inflammation resulting from strenuous exercise, and may cause hematuria (which itself may be called "exertion hematuria"), proteinuria, and cylinduria.^[4] However, athletic nephritis may be secondary to the hemoglobin load on the kidneys caused by the hemolysis in march hemoglobinuria. In most persons the effects of athletic nephritis are transient and disappear within hours to days after the end of exercise.^[4]

References

1. ^ Tobal D, Olascoaga A, Moreira G, Kurdian M, Sanchez F, Rosello M, Alallon W, Martinez FG, Noboa O (2008). "Rust Urine after Intense Hand Drumming Is Caused by Extracorpuscular Hemolysis". Clinical journal of the American Society of Nephrology 3: 1022–1027. 
2. ^ Gilligan DR, Blumgart HL (September 1941). "MARCH HEMOGLOBINURIA: Studies of the Clinical Characteristics, Blood Metabolism and Mechanism: with Observations on Three New Cases, and Review of Literature". Medicine 20 (3): 341–395. 
3. ^ Banga JP, Pinder JC, Gratzer WB, Linch DC, Huehns ER (November 1979). "An erythrocyte membrane-protein anomaly in march haemoglobinuria". Lancet 2 (8151): 1048–9. doi:10.1016/S0140-6736(79)92444-9. PMID 91785. 
4. ^ ^{a b} Gardner Jr, K. D. (1971). "Athletic nephritis: Pseudo and real". Annals of internal medicine 75 (6): 966–967. PMID 5167442.  edit [1]