Background/Aims: Temporary proteinuria post-exercise is common and is caused predominantly by renal haemodynamic alterations. One reason is up-regulation of angiotensin II (Ang II) due to the reducing effect of angiotensin-converting enzyme (ACE) inhibitors. However, another, ignored, reason could be the kininase effect of ACE inhibition. This study investigated how ACE inhibition reduces post-exercise proteinuria: by either Ang II up-regulation inhibition or bradykinin elevation due to kininase activity inhibition. Methods: Our study included 10 volunteers, who completed 3 high-intensity exercise protocols involving cycling at 1-week intervals. The first protocol was a control arm, the second evaluated the effect of ACE inhibition and the third examined the effect of angiotensin type 1 receptor blockade. Upon application, both agents reduced systolic and diastolic blood pressure; however, there were no statistically significant -differences. In addition, total protein, microalbumin and -β2-microglobulin excretion levels in urine specimens were analysed before, 30 min after and 120 min after the exercise protocols. Results: Total protein levels in urine samples were elevated in all 3 protocols after 30 min of high-intensity exercise, compared to baseline levels. However, both ACE inhibition and angiotensin type 1 receptor blockade suppressed total protein in the 30th min. In each protocol, total protein levels returned to the baseline after 120 min. Urinary microalbumin and β2-microglobulin levels during the control protocol were significantly higher 30 min post-exercise; however, only angiotensin type 1 receptor blockade suppressed microalbumin levels. Conclusion: The results indicated Ang II up-regulation, not bradykinin elevation, plays a role in post-exercise proteinuria.

Keywords:
Post-exercise proteinuria, Angiotensin II, Angiotensin converting enzyme inhibition, Angiotensin type 1 blockade
1.
Poortmans JR: Postexercise proteinuria in humans. Facts and mechanisms. JAMA 1985; 253: 236–240.
2.
Poortmans JR, Vanderstraeten J: Kidney function during exercise in healthy and diseased humans. An update. Sports Med 1994; 18: 419–437.
3.
O’Hagan KP, Casey SM, Clifford PS: Muscle chemoreflex increases renal sympathetic nerve activity during exercise. J Appl Physiol (1985) 1997; 82: 1818–1825.
4.
Cosenzi A, Carraro M, Sacerdote A, Franca G, Piemontesi A, Bocin E, Faccini L, Bellini G: Involvement of the renin angiotensin system in the pathogenesis of postexercise proteinuria. Scand J Urol Nephrol 1993; 27: 301–304.
5.
Esnault VL, Potiron-Josse M, Testa A, Ginet JD, Le Carrer D, Guenel J: Captopril but not acebutolol, prazosin or indomethacin decreases postexercise proteinuria. Nephron 1991; 58: 437–442.
6.
Peters H, Border WA, Noble NA: Angiotensin II blockade and low-protein diet produce additive therapeutic effects in experimental glomerulonephritis. Kidney Int 2000; 57: 1493–1501.
7.
Szekacs B, Vajo Z, Dachman W: Effect of ACE inhibition by benazepril, enalapril and captopril on chronic and post exercise proteinuria. Acta Physiol Hung 1996; 84: 361–367.
8.
Buleon M, Allard J, Jaafar A, Praddaude F, Dickson Z, Ranera MT, Pecher C, Girolami JP, Tack I: Pharmacological blockade of B2-kinin receptor reduces renal protective effect of angiotensin-converting enzyme inhibition in db/db mice model. Am J Physiol Renal Physiol 2008; 294:F1249–F1256.
9.
Vanhoutte PM: Endothelium and control of vascular function. State of the Art lecture. Hypertension 1989; 13: 658–667.
10.
Gunduz F, Kuru O, Senturk UK: Angiotensin II inhibition attenuates postexercise proteinuria in rats. Int J Sports Med 2005; 26: 710–713.
11.
Shephard RJ: Exercise proteinuria and hematuria: current knowledge and future directions. J Sports Med Phys Fitness 2016; 56: 1060–1076.
12.
Oken DE: An analysis of glomerular dynamics in rat, dog, and man. Kidney Int 1982; 22: 136–145.
13.
Iimura O, Ura N, Nakagawa M: Comparative hypertensionology-renal dopaminergic activity in experimental hypertensive rats. Clin Exp Hypertens 1997; 19: 117–130.
14.
McAllister RM: Adaptations in control of blood flow with training: splanchnic and renal blood flows. Med Sci Sports Exerc 1998; 30: 375–381.
15.
Middlekauff HR, Nitzsche EU, Nguyen AH, Hoh CK, Gibbs GG: Modulation of renal cortical blood flow during static ­exercise in humans. Circ Res 1997; 80: 62–68.
16.
Kang PM, Landau AJ, Eberhardt RT, Frishman WH: Angiotensin II receptor antagonists: a new approach to blockade of the renin-angiotensin system. Am Heart J 1994; 127: 1388–1401.
17.
Poortmans JR: Exercise and renal function. Exerc Sport Sci Rev 1977; 5: 255–294.
18.
Poortmans JR, Labilloy D: The influence of work intensity on postexercise proteinuria. Eur J Appl Physiol Occup Physiol 1988; 57: 260–263.
19.
Kocer G, Senturk UK, Kuru O, Gunduz F: Potential sources of oxidative stress that induce postexercise proteinuria in rats. J Appl Physiol (1985) 2008; 104: 1063–1068.
20.
Senturk UK, Kuru O, Kocer G, Gunduz F: Biphasic pattern of exercise-induced proteinuria in sedentary and trained men. Nephron Physiol 2007; 105:p22–p32.
21.
Gunduz F, Senturk UK: The effect of reactive oxidant generation in acute exercise-induced proteinuria in trained and untrained rats. Eur J Appl Physiol 2003; 90: 526–532.
22.
Nicholls MG, Charles CJ, Crozier IG, Espiner EA, Ikram H, Rademaker MJ, Richards AM, Yandle TG: Blockade of the renin-angiotensin system. J Hypertens Suppl 1994; 12:S95–S103.
23.
Zatelli A, Roura X, D’Ippolito P, Berlanda M, Zini E: The effect of renal diet in association with enalapril or benazepril on proteinuria in dogs with proteinuric chronic kidney disease. Open Vet J 2016; 6: 121–127.
24.
Maschio G, Cagnoli L, Claroni F, Fusaroli M, Rugiu C, Sanna G, Sasdelli M, Zuccala A, Zucchelli P: ACE inhibition reduces proteinuria in normotensive patients with IgA nephropathy: a multicentre, randomized, placebo-controlled study. Nephrol Dial Transplant 1994; 9: 265–269.
25.
Poortmans JR, Brauman H, Staroukine M, Verniory A, Decaestecker C, Leclercq R: Indirect evidence of glomerular/tubular mixed-type postexercise proteinuria in healthy humans. Am J Physiol 1988; 254:F277–F283.
26.
Clerico A, Giammattei C, Cecchini L, Lucchetti A, Cruschelli L, Penno G, Gregori G, Giampietro O: Exercise-induced proteinuria in well-trained athletes. Clin Chem 1990; 36: 562–564.
27.
Robertshaw M, Cheung CK, Fairly I, Swaminathan R: Protein excretion after prolonged exercise. Ann Clin Biochem 1993; 30(pt 1): 34–37.
28.
Zambraski EJ, Bober MC, Goldstein JE, Lakas CS, Shepard MD: Changes in renal cortical sialic acids and colloidal iron staining associated with exercise. Med Sci Sports Exerc 1981; 13: 229–232.
29.
Poortmans JR, Blommaert E, Baptista M, De Broe ME, Nouwen EJ: Evidence of differential renal dysfunctions during exercise in men. Eur J Appl Physiol Occup Physiol 1997; 76: 88–91.
30.
Cianflocco AJ: Renal complications of exercise. Clin Sports Med 1992; 11: 437–451.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.