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Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Research output: Contribution to journalArticlepeer-review

  • Kelsley E. Joyce
  • John Delamere
  • Susie Bradwell
  • Stephen David Myers
  • Kimberly Ashdown
  • Carla Rue
  • Samuel J. E. Lucas
  • Owen D. Thomas
  • Amy Fountain
  • Mark Edsell
  • Dr Fiona Myers
  • Will Malein
  • Chris Imray
  • Alex Clarke
  • Chrisopher T. Lewis
  • Charles Newman
  • Brian Johnson
  • Patrick Cadigan
  • Alexander Wright
  • Arthur Bradwell
Introduction: Proteinuria increases at altitude and with exercise, potentially as a result of hypoxia. Using urinary alpha-1 acid glycoprotein (α1-AGP) levels as a sensitive marker of proteinuria, we examined the impact of relative hypoxia due to high altitude and blood pressure-lowering medication on post-exercise proteinuria.

Methods: Twenty individuals were pair-matched for sex, age and ACE genotype. They completed maximal exercise tests once at sea level and twice at altitude (5035 m). Losartan (100 mg/day; angiotensin-receptor blocker) and placebo were randomly assigned within each pair 21 days before ascent. The first altitude exercise test was completed within 24–48 hours of arrival (each pair within ~1 hour). Acetazolamide (125 mg two times per day) was administrated immediately after this test for 48 hours until the second altitude exercise test.

Results: With placebo, post-exercise α1-AGP levels were similar at sea level and altitude. Odds ratio (OR) for increased resting α1-AGP at altitude versus sea level was greater without losartan (2.16 times greater). At altitude, OR for reduced post-exercise α1-AGP (58% lower) was higher with losartan than placebo (2.25 times greater, p=0.059) despite similar pulse oximetry (SpO2) (p=0.95) between groups. Acetazolamide reduced post-exercise proteinuria by approximately threefold (9.3±9.7 vs 3.6±6.0 μg/min; p=0.025) although changes were not correlated (r=−0.10) with significant improvements in SpO2 (69.1%±4.5% vs 75.8%±3.8%; p=0.001).

Discussion: Profound systemic hypoxia imposed by altitude does not result in greater post-exercise proteinuria than sea level. Losartan and acetazolamide may attenuate post-exercise proteinuria, however further research is warranted.
Original languageEnglish
Article numbere000662
Number of pages10
JournalBMJ Open Sport and Exercise Medicine
Issue number1
Publication statusPublished - 26 Mar 2020


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