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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

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Exertional hematuria: definition, epidemiology, diagnostic and clinical considerations

Giuseppe Lippi
  • Corresponding author
  • Section of Clinical Biochemistry, University of Verona, Piazzale LA Scuro, 37134 Verona, Italy
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  • Other articles by this author:
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/ Fabian Sanchis-Gomar
  • Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
  • Other articles by this author:
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Published Online: 2019-06-11 | DOI: https://doi.org/10.1515/cclm-2019-0449


Exertional hematuria can be considered a subcategory of exercise-induced hematuria, characterized by painless appearance of erythrocytes in urine after recent physical exercise, not directly attributable to external traumatic injuries to the genitourinary system, and spontaneously resolving with rest. Although its frequency has enormous heterogeneity, depending on the athlete population, duration and intensity of exercise, technique used for identifying or quantifying hematuria and relative diagnostic thresholds, what clearly emerges from the scientific literature is that a certain degree of hematuria is commonplace after non-contact sports, especially running. This exertional hematuria, which appears self-limiting, may be attributable to some frequently concomitant causes, involving organs of the genitourinary system, and mostly encompassing bladder or urethral injuries. Renal injuries caused by internal movements, vascular spasm and ischemia are also potential causes of increased glomerular permeability to erythrocytes, whilst the presence of preexisting genitourinary diseases cannot be ruled out, especially when post-exercise hematuria is recurrent or endures. Therefore, whenever hematuria is observed in a random urine specimen, recent sports performance (especially running) should be investigated and urinalyses scheduled for the following days. When no temporal association of hematuria with exercise can be found, when genitourinary traumas have been excluded or hematuria persists for >72 h, specific diagnostic investigations should be planned to identify possible genitourinary diseases.

Keywords: hematuria; physical exercise; sports; urine


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About the article

Corresponding author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, Piazzale LA Scuro, 37134 Verona, Italy

Received: 2019-04-30

Accepted: 2019-05-01

Published Online: 2019-06-11

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), 20190449, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2019-0449.

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