title: Urine dipstick analysis for identification of runners susceptible to acute kidney injury following an ultramarathon.
abstract: This study examined whether urine dipstick testing might be useful to predict the development of acute kidney injury after an ultramarathon. Participants in the 2011 161-km Western States Endurance Run underwent post-race blood and urine dipstick analyses. Of the 310 race finishers, post-race urine dipstick testing was completed on 152 (49%) and post-race blood also was obtained from 150 of those runners. Based on "injury" and "risk" criteria for acute kidney injury of blood creatinine 2.0 and 1.5 times estimated baseline, respectively, 4% met the criteria for injury and an additional 29-30% met the criteria for risk of injury. Those meeting the injury criteria had higher creatine kinase concentrations (P < 0.001) than those not meeting the criteria. Urine dipstick tests that read positive for at least 1+ protein, 3+ blood, and specific gravity ≥ 1.025 predicted those meeting the injury criteria with sensitivity of 1.00 (95% confidence interval [CI] 0.54-1.00), specificity of 0.76 (95% CI 0.69-0.83), positive predictive value of 0.15 (95% CI 0.06-0.30), negative predictive value of 1.00 (95% CI 0.97-1.00), and likelihood ratio for a positive test of 4.2. We conclude that urine dipstick testing was successfully able to identify those individuals meeting injury criteria for acute kidney injury with excellent sensitivity and specificity.
authors.affiliation: Department of Physical Medicine & Rehabilitation-117, Sacramento VA Medical Center, 10535 Hospital Way, Sacramento, CA 95655-1200, USA. martin.hoffman@va.gov
authors.forename: Martin D
authors.initials: MD
authors.lastname: Hoffman
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Stuempfle
authors.forename: Kevin
authors.initials: K
authors.lastname: Fogard
authors.forename: Tamara
authors.initials: T
authors.lastname: Hew-Butler
authors.forename: James
authors.initials: J
authors.lastname: Winger
authors.forename: Robert H
authors.initials: RH
authors.lastname: Weiss
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000652:urine*; D000328:Adult; D003402:Creatine Kinase / Q000652:urine*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D005082:Physical Exertion / Q000502:physiology*; D011507:Proteinuria / Q000652:urine*; D012307:Risk Factors; D012420:Running / Q000502:physiology*; D013046:Specific Gravity; D016482:Urinalysis / Q000379:methods
chemical_list: D003404:Creatinine; D003402:Creatine Kinase