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Physiological changes of the kidneys and urinary tract

More than 100 years ago W. Leube (1878) first described the development of proteinuria in healthy people after exercise. Later W. Collier (1907) noted transient proteinuria, a Barach (1910) revealed hematuria and cylindruria in athletes after the competition. Although this issue has long been the subject of research of a large number of authors, many of the questions of etiology, pathogenesis and clinical especially the evaluation of observables in athletes changes in the urine is still far from solution. The literature on this issue suggests that there is a tendency to view all changes in renal function identified in athletes, as a kind of "feature"that occurs under the influence of physical loads, just as is the case in relation to the number of changes of cardiovascular system. But if in the latter case, thanks to the ongoing deep clinical analysis there are real ways differential diagnosis of the true characteristics of the heart of an athlete may have them pathological conditions, in relation to the study of the kidneys this situation yet. At the same time found in athletes urine changes cannot always be considered as a physiological response to exercise. In a certain percentage of cases they are symptoms of a pathological process in the kidneys. It can be argued on the basis of individual messages, because statistically reliable data on chronic kidney disease in athletes in the literature no. Thus, according to Ukrainian Republican medical-sports clinic, and summarized the results of observations 1188 leading athletes in 1961 - 1962, 5.6 % of cases revealed pathological changes of the kidneys and urinary tract; mostly chronic nephritis. Kidney diseases was also observed 1.1 % athletes (who needed treatment), under the supervision of the Leningrad city medical exercises dispensary in 1962 For the period from 1965 to 1970 in the hospital of the Moscow city medical exercises dispensary was about diseases of the urinary tract 181 sportsman, from them 11-about pyelonephritis. Among 3752 athletes treated in the therapeutic Department of the clinic in the last 10 years, people with kidney disease was 5 %. A fundamentally important position, from which it is necessary to proceed with the assessment of changes in the urine in athletes, is that the so-called physiological changes can be detected only after exercise sufficient intensity. At rest, in a period of rest from muscular activity, urine healthy athletes should not contain pathological elements. This is evidenced by the results of researches M. Gagljo, R. Mineo (1961), who studied for 10 years to change the composition of urine in 96 athletes and watching the onset proteinuria, hematuria and zilindruria only after intense physical exercise. In the work of W. Sidorowicz (1963) the data about the nature of changes in the urine detected during the examination 556 healthy active sportsmen from 61 people, i.e. 11 % of cases. It turned out that the most common deviation from the norm is present in the urine of erythrocytes (fresh and leached) and protein.
Similar data on the frequency of changes in the urine in athletes can be found in more recent studies, E. Yu. of Chamisa (1975). After studying medical-control cards 5580 athletes, which had been under observation at the Leningrad medical exercises dispensary n 1968-1972, he revealed a single or multiple changes in the urine of 482 people (8,6 %)3. Of them isolated proteinuria marked only 17,6 % of the athletes, while the combination of proteinuria with hematuria were observed in 47,7%and with cylindruria - 34,7% of the athletes.
An analysis of changes in the urine of these athletes taking into account primary focus of the training process showed that they especially often (16,1 %) occur off the trainees on the speed and endurance.
Along with this, there are indications that the sportsmen of high qualification, engaged in various kinds of sports, often there is only proteinuria, while other changes in the urine is not defined. In this regard deserve the attention of the data obtained using electron microscopy methods. In the study of ultrastructure of glomeruli found that glomerular capillary barrier allow the passage of proteins without pathological changes of basal membrane. This proteinuria is estimated as physiological, if it is within 40 to 150 mg/day, and excreted in the urine protein consists mainly albumin (64 %) and low-molecular protein, relative molecular mass of which does not exceed 90 000.