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→NSAIDs and Acute kidney failure
=NSAIDs and Acute kidney failure=
Kidney failure while running is extremely rare, and seems to require multiple factors to come together. Looking<ref name="rhabdo1"/> at the [http://en.wikipedia.org/wiki/Comrades_Marathon Comrades Marathon], a 90 Km/56 Mile ultramarathon in South Africa, there have only been 19 cases of kidney failure between 1969 and 1986, it even though thousands of people participate each year<ref name="rhabdo1"/>. The following are considered factors in acute kidney failure related to running.
* '''Dehydration'''. Exercise reduces blood flow to the kidneys and dehydration makes this worse.
* '''NSAIDs'''. NSAIDs also reduce blood flow to the kidneys <ref name="coxibs"/>. NSAIDs reduce prostaglandin production, and prostaglandins are vital to maintaining blood flow to the kidneys. While NSAIDs are considered safe drugs, NSAIDs are associated with a relatively high incidence of adverse drug reactions involving the kidneys. Generally NSAID side effects are restricted to individuals with predisposition to kidney problems, so extra care should be taken if you have a history of kidney problems. However, athletes push their bodies to extremes, so what applies to the general population may not be valid for runners. One runner was told<ref name="Anecdote"/> by doctors that 2400mg Ibuprofen in an ultramarathon was a contributing factor to his kidney failure.
* '''Rhabdomyolysis'''. All strenuous exercise causes some muscle damage, but this is generally resolved without a problem. However large amounts of a protein called myoglobin from damaged muscle can cause a condition called [http://en.wikipedia.org/wiki/Rhabdomyolysis rhabdomyolysis] (AKA 'rhabdo'). While serious rhabdomyolysis is rare, it is worth understanding one key symptom, which is low volume, dark urine, often likened to 'coca-cola'. The other symptoms include severe, incapacitating muscle pain and elevated levels of creatine kinase (CK) in the blood (which requires a specialist test). Some individuals<ref name="rhabdoGenes"/> have a genetic condition that makes rhabdomyolysis possible after relatively moderate exercise. Rhabdomyolysis is also more likely after eccentric exercise, such as [[Downhill Running]].
* '''Sickness'''. A viral or bacterial infection is often a factor in exercise related kidney failure.
Looking at the analysis<ref name="coxibs"/> of nine cases of continued kidney failure in Comrades Marathon, seven had taken NSAIDs, four may have had a viral or bacterial infection. The combination of dehydration, rhabdomyolysis, infection and NSAIDs are a perfect storm for the kidneys.
=NSAIDs and Hyponatremia=
