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An 18-year-old Japanese boy developed a severe loin pain 6 h after performing a 200 m dash three times in a baseball training, and was admitted to our hospital. He had a history of acute renal failure with severe loin pain after anaerobic exercise (ALPE) following the same kind of exercise 2 years before. On admission, his serum creatinine (Cr) level was 292 μmol/l (3.3 mg/dl) without accompanying findings of rhabdomyolysis-like elevation of creatine phosphokinase or myoglobinuria. Renal stones were not detected either by plain abdominal X-ray or by sonography. Accordingly, a diagnosis of ALPE was made. We started hydration and pain control by pentazocine without using non-steroidal anti-inflammatory drugs (NSAIDs). ALPE [1] is an uncommon syndrome, which mainly occurs in Asians possibly because of the relatively high prevalence (0.15–0.6%) of renal hypouricaemia [2,3,4]. The pathogenesis of ALPE is not clearly understood, but is considered to be a severe arterial vasoconstriction in the kidney. ALPE is known to demonstrate patchy wedge-shaped defects by contrast media-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) in delayed phase, which are considered to reflect renal ischaemia caused by vasospasm [5]. 99mTc-methylene diphosphonate (MDP) bone scintigraphy is also helpful to diagnose ALPE and to detect its ischaemic regions [6]. However, it requires time to start and to perform these imaging tests, and besides, contrast media for CT or MRI may cause harm, especially to patients with impaired renal function. Thus, we attempted to detect ischaemic regions caused by ALPE with colour Doppler imaging, which is non-invasive and can be implemented at any time and at the patients’ bedside. The use of micro-bubble contrast agent

Acute renal failure with severe loin pain after anaerobic exercise (ALPE): detection of patchy renal ischaemia by contrast-enhanced colour Doppler