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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 2  |  Page : 241-243
Renal Allograft in a Professional Boxer


1 Nephrology and Urology Research Center (NURC), Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Shahid Beheshti University of Medical Sciences, Tehran, Iran

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   Abstract 

Significant health benefits result from regular physical activity for kidney transplant recipients. Nevertheless, some adverse effects also have been shown to be associated with highly intensive exercises. We report a kidney transplant professional boxer whose kidney allograft has remained in good health, despite his violent sport activities.

Keywords: Sports, Allograft, Risk

How to cite this article:
Einollahi B, Nafar M, Taheri S, Nemati E. Renal Allograft in a Professional Boxer. Saudi J Kidney Dis Transpl 2008;19:241-3

How to cite this URL:
Einollahi B, Nafar M, Taheri S, Nemati E. Renal Allograft in a Professional Boxer. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Dec 8];19:241-3. Available from: http://www.sjkdt.org/text.asp?2008/19/2/241/39038

   Introduction Top


As a violent exercise, boxing has the potential to induce serious injuries to several organs of the human body. It has been demons­trated that 10-15% of all boxing-induced trauma is related to visceral injuries that may include renal injury. [1],[2],[3],[4],[5],[6] Every direct blow to the abdomen or flunk can produce considerable kidney damage. We report a case of renal transplantation in a profe­ssional boxer whose renal graft survived the violence of his practices.


   Case report Top


A 29-year-old professional boxer, who was under conventional thrice weekly hemo­dialysis (HD) for 4 months, received a kidney transplant at our kidney transplantation department, in July 2004. The exact cause of renal failure of his native kidneys was unknown. However, the patient had a his­tory of use of supplementary protein powders and performance enhancing and recreational drugs for several years, and he was involved in a significant traumatic and strenuous exercise. His past medical history included a well-controlled hypertension using captopril 25 mg twice daily. He did not have a signi­ficant family history. Kidney transplantation was performed from a 25-year-old male living unrelated donor with the same blood group (B+), but of full mismatch HLA types.

The patient was immunosuppressed with triple therapy that included cyclosporine 7 mg/kg/day, prednisone 1mg/kg/day, and mycophenolate mofetil (MMF) 2 g/day. Other medications included diltiazem, capto­pril, calcitriol, ranitidine, acetyl salicylic acid (ASA), folic acid, and oral nystatin. Within the first week post-transplantation, the patient revealed a rise in serum alanine transferase (ALT) and aspartate transferase (AST) levels. Accordingly, the cyclosporine dosage was rapidly decreased to 4 mg/kg/day within 21 days. The patient was discharged from the hospital with serum creatinine level of 2.3 mg/dL and blood pressure of 120/80 mmHg.

After discharge from the hospital, the patient was regularly followed up at our outpatient kidney transplantation clinic. Within one year, he developed hyper­lipidemia (triglycerides 403 mg/dL and total cholesterol 245 mg/dL), therefore atorvastatin 20 mg/day was prescribed.

During the 32 months of follow-up after transplantation, the patient ignored the strong recommendations of his physicians to leave professional boxing activities; and began to raise his exercise intensity and also returned to use protein powders for body building. Within one year, his weight reached 98 kg and he participated in his first professional boxing game.

However, this time, he sought the medical advice of his nephrologist before engaging in this activity. His cyclosporine dose was 200 mg/day, prednisone 7.5 mg/day, and MMF 1.5 g/day. His laboratory investigations revealed creatinine 1.7 mg/dL, cholesterol 245 mg/dL, triglyceride 403 mg/dL, cyclos­porine trough blood level (C0) 100 ng/mL, cyclosporine 2-hours post dose blood level (C2) 440 ng/mL. Other laboratory measurements including liver function tests were within normal limits. In fact, during his post transplantation period, his serum crea­tinine values were always within the range of 1.7 to 2.3 mg/dL. According to our assessment, the patient remained in a stable condition during 32 months of follow-up after renal transplantation, despite his vigo­rous and traumatic exercises.


   Discussion Top


Regular physical activity is highly recommended in renal transplant patients. [1],[2],[3],[6] Metabolic disturbances, anemia, insulin resis­tance, and lipid disorders, which are frequent complications in this patient population, are speculated to ameliorate with regular exercise. [2] There is even a especial inter­national sport event for transplant patients that include sports such as pin bowling, tennis, volleyball, mini-marathon, swimming, table tennis, badminton, squash, golf, lawn bowls, and cycling. However, most inves­tigators believe that these exercises should be limited, controlled and under careful supervision of physicians. [2],[3]

Data suggests an incidence of catastrophic kidney related injury of 0.4 per 1 million children per year from all sports; cycling was the most common cause. [7] In one study, pediatric nephrologists were asked to indicate their recommendations for participation of children with single native kidneys in contact/collision sports. The survey revealed that 62% of respondents would not allow participation in contact/collision sports. Eighty-six barred participation in American football, whereas only 5% barred cycling. Most cited fear of traumatic loss of renal function as a reason for discouraging parti­cipation. The authors concluded that kidney injury from sports was less common than catastrophic brain, spinal cord, or cardiac injury and recommended not to restrict contact sports for preventing kidney damage; although their survey did not include questions about renal allograft. [7] In another study, it was demonstrated that after a single boxing game, 60% of normal athletes revealed significant albuminuria, 73% hema­turia, and 26% granular or hyaline casts in their urine from their native kidneys. [5]

Despite the fact that our patient had a good renal allograft function following 32 months of kidney transplantation despite his professional boxing activities, we should not disregard the risk of such vigorously traumatic exercises for a kidney allograft. Another important aspect that should be considered is whether the renal allograft can undergo repeated traumatic experiences without cumulative damage. Moreover, a kidney allograft lacks some anatomical pro­tection against trauma compared to a normal kidney, in addition to the immunological suppression.

According to available data, we suggest to minimize the risk of kidney damage, all kidney allograft recipients should avoid highly intensive and traumatic exercises; although participation in regular physical activity is highly recommended.

 
   References Top

1.Fuhrmann I, Krause R. Principles of exercising in patients with chronic kidney disease, on dialysis and for kidney transplant recipients. Clin Nephrol 2004;61(Suppl 1):S14-25.  Back to cited text no. 1  [PUBMED]  
2.Stefanovic V, Milojkovic M. Effects of physical exercise in patients with end stage renal failure, on dialysis and renal trans­plantation: Current status and recommend­dations. Int J Artif Organs 2005;28(1):8-15.  Back to cited text no. 2    
3.Yango AF, Gohh RY, Monaco AP, et al. Excess risk of renal allograft loss and early mortality among elderly recipients is associated with poor exercise capacity. Clin Nephrol 2006;65(6):401-7.  Back to cited text no. 3    
4.Jordan BD, ed. Medical Aspects of Boxing. CRC Press, Inc: Boca Ratan, FL; 1993. p. 270-5.  Back to cited text no. 4    
5.Amelar RD, Solomon C. Acute renal trauma in boxers. J Urol 1954;72:145-8.  Back to cited text no. 5  [PUBMED]  
6.Iborra Molto C, Pico Vicent L, Montiel Castillo A, Clemente Ramon F. Quality of life and exercise in renal disease. Edtna Erca J 2000;26(1):38-40.  Back to cited text no. 6    
7.Grinsell MM, Showalter S, Gordon KA, Norwood VF. Single kidney and sports participation: Perception versus reality. Pediatrics 2006;118(3):1019-27.  Back to cited text no. 7    

Top
Correspondence Address:
Behzad Einollahi
Nephrology and Urology Research Center (NURC), Baqiyatallah University of Medical Sciences, Mollasadra St., Vanak sq, Tehran
Iran
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PMID: 18310875

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    Abstract
    Introduction
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    Discussion
    References
 

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