A 30 year old woman was admitted to our hospital after she had bloody urine and difficulty peeing.
Usually, a young person like this has some severe medical problem that requires significant renal work up (a lot of urine tests, blood tests, ultrasound or CT scan, maybe a renal biopsy) but she said something in her history that made us realize that it was something else: she had recently joined an "interval training" gym. Don't want to name any trademark names here!
She said she was getting married in two months and her dress no longer fit. So she decided to lose weight. She tried dieting for a few days and when her weight didn't really change she decided to join a gym. The first day, the work out was one hour long and she tried to match her workout capacity from college. Big mistake as she hadn't worked out in over 6 years!
She couldn't finish the work out but did manage to last 40mins. Afterwards, she could barely walk! Her muscles were weak, her body felt heavy and she felt very lethargic. She decided to go home and rest - she slept 12 hours! When she woke up - she was swollen all over. She went to urinate and what came out was minimal bloody urine. This scared her and she finally decided to come to the hospital!
In the ER she was found to be hypertensive, edematous, lethargic, confused and her labs showed kidney failure and blood in her urine. In our worry for this poor woman we started treating her with fluids and started checking her for every kind of renal failure cause - ultrasound, cultures, HIV, toxicology but nothing was turning up! Other labs were coming back slowly. Also, with IV hydration we were making the swelling worse! Her mother, fatefully said: I wish she had just gotten her dress let out.
This comment lead to a conversation about her desired weight loss, the failure in doing so and the eventual excessive exercising - prompting us to check a CPK level! This is normally a test we do to most our renal failure patients but in the excitement of her severe renal disease and bloody urine - we never thought it could the simplest thing.
Her CPK levels were sky high and she had severe rhabdomyolysis! CPK is a muscle breakdown protein and in excess amounts it can damage the kidneys. A simple diagnosis but it's all simple in hindsight!
She was continued on IV fluids but her numbers were not improving. And, now she was getting short of breath because the IV fluid was ending up in her lungs. So we decided to start dialysis. Luckily, she only needed this three times because she started to produce urine! Until now, she had not produced any. Things then improved from there. The worst 5 days of this girls life!
So, next time you decide to lose weight - talk to your doctor or a nutritionist and take it slowly. No short cuts in life. Even something as healthy as excercise could end up hurting you!