EXERCISING THE KIDNEY
With the focus of exercise usually on metabolism and performance of muscles, the effects of physical exertion on other organs might be forgoten. The kidney plays critical roles in maintaining hydration and electrolyte balance, removing waste, and regulating acid-base balance.
THE KIDNEY'S ROLE
The kidneys play a pivotal and essential role in maintaining hydration
of the body, or body fluid homeostasis. If the body is in a situation where
a fluid deficit exists (e.g. dehydrated state), there will be a compensatory
decrease in the production of urine and the small amount of urine produced
will be extremely concentrated; it will appear very yellow in color. If
fluid intake is excessive or if the body is overly hydrated, the kidneys
attempt to correct this situation by increasing the production of urine;
the urine will be very dilute and clear in color.
Urine output for a normal adult dog usually ranges from 0,8 to 1,8
liters per day. This filtration volume is needed to deliver large amounts
of metabolic by-products and toxins to the urine for elimination from the
body. More than 99% of this filtrate is reabsorbed by increased water and
salt reabsorption in the proximal and distal segments of the nephrons;
pure water is reabsorbed in the collecting ducts of the nephrons as well.
The effect in the proximal tubules is related to glomerular blood flow;
that in the distal tubule occurs via the action of aldosterone, a hormone
generated from the adrenal glands in response to water and salt depletion.
The effect in the collecting ducts occurs via the action of anti-diuretic
hormone (vasopressin), a hormone released by the brain in response to decreased
volume of fluid in the heart and/or increased concentration of solutes
in extracellular body fluids.
THE KIDNEY FUNCTION IS CHANGEING DURING EXERCISE
Exercise produces changes in renal hemodynamics with alterations in
electrolyte and protein excretion. Effective renal blood flow seems to
be reduced relative to the intensity of exercise such that renal blood
flow decreases with increasing intensity of exercise. This is the result
of the shunting of blood away from the renal and splanchnic vascular beds
to exercising muscles. Renal blood flow relative to cardiac output may
be quite low during exercise, but the absolute flow really is quite consistent
at rest or exercise.
In the case of vigorous exercise accompanied by large fluid losses,
increased water and salt reabsorption occurs in the proximal and distal
tubules. The additional water reabsorption in the collecting ducts is related
to elevated levels of anti-diuretic hormone in the blood. The water and
salt reabsorbed from the urinary filtrate is returned to the blood vessels.
Although this conservation of body water and electrolytes is beneficial
for an athlete, there is a misconception about its importance. Because
urine production at rest is relatively low , the maximum amount of water
that could be conserved by the kidneys during exercise is of little consequence.
The kidneys' real importance is during the 24-48 hour period after exercise,
in terms of recovery from a dehydrated state and the restoration of body
fluids.
DEHYDRATION HURTS THE KIDNEY
Severe dehydration associated with low blood volume will cause poor
renal blood supply and poor renal delivery of oxygen and glucose, especially
to the renal tubular cells. If a critical level of supply is not maintained
to these cells, injury occurs to the cell membranes and energy sources
inside the tubular cells are depleted.
The resultant clinical condition, acute tubular
necrosis, occurs only with severe acute fluid losses (eg., hemorrhage)
or severe dehydration ( acute loss of 15% or more of body weight in fluids),
and can lead to the inability to excrete waste products, electrolyte disturbances
and acute renal failure. This condition may be self-limited with recovery
in days to weeks or may lead to permanent renal damage.
With the levels of dehydration typically seen in athletes under stresfull
conditions, generally in the range of 5-8%, we don't know if there are
any permanent ill effects of dehydration on the kidney. The possibility
of negative consequences was first raised by studies examining the urinary
profiles of dehydrated dogs. The findings showed the excretion of leucine
amino peptidase, an enzyme that may indicate kidney damage.
KIDNEY STONE AND DEHYDRATION
Kidney stones, or renal calculi, are crystalline structures that typically
contain phosphate or calcium oxalate as the sole or major component. There
is no single explanation of the cause and development of stones. In all
probability, stones result from the interaction of multiple factors. It
is generally thought that a period of abnormal crystalluria is required
during which large crystals, or aggregates, are produced in the urine.
In order for these crystals to continue to grow, a certain number of chemical
factors must be present - i.e., the urine must be supersaturated with the
salt of the stone-forming crystal; certain inhibitory factors of crystallization
must be reduced or absent from the urine; and the environment in the urine
must be conducive to the aggregation of the crystals.
Kidney stones may form in the kidney, in the ureter draining the urine
from the kidney, or in the bladder in susceptible individuals. This usually
occurs secondary to a urinary tract infection or in individuals who have
high urinary calcium excretion, a condition that is most commonly seen
in relation to excessive calcium and/or vitamin D intake.
The most likely candidates for a kidney stone are the dogs with diets
high in oxalate or from excessive vitamin C intake, or high uric acid excretion,
or related to high protein intake, may lead to stone formation.
Males are more likely to form stones because they have more calcium
and uric acid in their urine, and because they are worked in the
heat and become dehydrated. It is dehydration, not exercise - that increases
the risk of stone formation.
Recent studies finds that individuals who eat the most calcium have
the lowest risk of stones. Because calcium binds oxalate in the gut, so
it passes in the stool and does not enter the body. Sodium is not
a key risk for renal stones, yet cutting sodium can lower the risk of stones.
This is because sodium and calcium seem to compete for absorption by renal
tubules. So the less sodium you eat, the less calcium stays in the urine.
Nevertheless, sodium-induced calcium stones in susceptible individuals
probably occur as a result of chronic exposure to sodium. Very prolonged
intake of excess sodium would be required to develop the high urine sodium
excretion that apparently contributes to this condition.
The dehydration resulting from exercise increases the concentration
of calcium and oxalate in the urine. In normal individuals, the conditions
are not such that this results in formation of kidney stones. In individuals
with defects in calcium and/or oxalate excretion, the conditions of hypercalcuria
and/or high excretion of oxalate plus dehydration may cause problems.
The most critical tip to preventing stones is to quaff fluids
-one or more liters per day - to keep the urine dilute. Other dietary tips
include eating more potassium (which somehow lowers urinary calcium excretion),
cutting oxalate-rich foods , avoiding large doses of vitamin C, and reducing
animal protein in the diet.
THE KIDNEYS REGULATE THE LEVELS OF SODIUM AND OTHER ELECTROLYTES IN THE BODY
The kidneys help maintain normal body levels of sodium and other electrolytes
by urinary retention and/or excretion of these electrolytes. Sodium and
chloride are the major extracellular electrolytes. The level of these two
ions in the extracellular fluid compartment must be kept in a relatively
narrow normal range for proper body function. Sodium and chloride are freely
filtered into the urinary filtrate in the glomeruli, and reabsorption in
the proximal and distal tubules occurs based on renal blood supply, circulating
blood volume and electrolyte levels. If blood volume is low, as occurs
with hemorrhage or dehydration, sodium and chloride reabsorption is increased
and water is reabsorbed with these solutes. In the event of total body
depletion of sodium and/or chloride, blood volume is often low as well
since vascular volume is dependent on adequate solutes in the blood. In
this case, sodium and chloride reabsorption with water is again maximized
in the kidney. Under appropriate conditions, like dehydration or salt depletion,
urinary levels of sodium and chloride are quite low. Even though urine
flow and salt excretion can be dramatically curtailed under appropriate
conditions, it can never be diminished to zero.
Conversely, the kidneys can dump huge amounts of sodium to compensate
for a high sodium intake. Sodium in general does not stress kidneys, but
controversy exists on sodium and blood pressure. Sharply cutting salt can
lower blood pressure. Surely most athletes, who lose sodium, need to restore
it in a sports drink, for example.
HIGH PROTEIN DIETS AND ITS EFFECT ON THE KIDNEY
High dietary protein or amino acids accelerate the progression of renal
disease. A key issue is that amino acids are renal vasodilators. As such,
they decrease pre-glomerular vascular resistance, thereby exposing the
glomerular capillary to a greater-than-normal hydrostatic pressure. The
resultant "glomerular hypertension" causes glomerulosclerosis and damage
to the nephron.
Based upon what we currently know, I feel it is appropriate to caution
trainers that excessive amino acid or protein dietary intake on a chronic
basis could damage the kidney by elevating glomerular capillary pressure
and causing glomerulosclerosis. This deleterious effect may increase the
possibility of renal disease later in life.
A low-protein diet can help prevent glomerular hypertension and thus
slow glomerular sclerosis in residual healthy nephrons.
A high protein diet, with its load of urea, phosphate, sulfate, urate,
and hydrogen ions, raises glomerular filtration rate, whereas a low protein
diet lowers it. But in healthy dogs, this has no demonstrable consequence.
EXERCISE-RELATED ACUTE RENAL FAILURE
This is an uncommon syndrome of oliguria or anuria with renal (mostly
"tubular") dysfunction that usually occurs during long show when the physiologic
decrease in renal blood flow is augmented by blood loss, heat stress, dehydration,
and exertional rhabdomyolysis (the breakdown of skeletal muscle). It also
occurs and can kill via hyperkalemic cardiac arrhythmias. Risk factors
include low fitness, unwise exertion, and poor hydration.
Fortunately, exercise induced acute renal failure is rare. For reasons
which are unclear, adequate glomerular filtration is maintained at normal
levels, despite intense neurally mediated renal vasoconstriction during
exercise.
Rhabdomyolysis is a key event, in association with exercise, that may
precipitate acute renal failure. Rhabdomyolysis is most likely to occur
in situations that include one or more of the following: prolonged intense
exercise, heat stress, dehydration, and potassium depletion. There are,
however, reports of rhabdomyolysis and renal failure occurring in untrained
subjects following short term maximal exercise.
Preceding infectious processes, especially vital, may predispose one
to muscular injury that could precipitate rhabdomyolysis. This may be exacerbated
by use of analgesics (aspirin and non-steroidal anti-inflammatory agents)
for minor injuries. These drugs inhibit the renal vasodilatory prostaglandin
production. Therefore, an important compensatory mechanism for the physiologic
decrease in renal blood flow is impaired. This effect increases the risk
for renal ischemia. Myoglobinuria, hemoglobin-uria and nephrotoxic drugs
may intensify the physiologic renal response to exercise. This, in combination
with volume depletion, leads to renal ischemia and acute renal failure.
In this situation, the cornerstone of management is early and aggressive
fluid replacement. Urine output should be closely monitored and if the
dog is oliguric for more than a few hours, hospitalization may be necessary
for intravenous volume expansion and observation.
CONCLUSIONS
The kidney serves a critical role in helping to maintain normal homeostasis
(fluid and electrolyte balance) during, and more importantly after exercise.
The effects of exercise on the kidney are unclear. More than likely,
exercise has large indirect effects on acute kidney function via altered
blow flow and possible dehydration.
The biggest problem in dogs mortality is the renal failure. Renal failure
can appear by age or after a sustained effort. Exercising the kidneys like
all the other parts of his body is an important thing.
But how can we exercise the Kidneys? The answer is by making them work
during feeding and training.
During the hard trainings the kidneys are playing an important work
by filtering the residues and also by maintaining an equilibrium in the
hydro-electrolytic balance.
During feeding, if you feed them liquid meals the excess liquid will
be eliminated trough the kidneys, making them work. The excess liquid in
the feed makes the kidneys filter more easy the residue in the body. The
residues are usually eliminated trough fecales and urine. If the urine
is concentrated with residues then each time they will pass the urinary
system they will affect the glomerules of the kidney and in time can lead
to renal failure.
These are only some general guidlines that all of us know but you always
have to remember that each dog is an individual and we have to adapt to
their needs.