Extensive repetitive calisthenics performed by Marine recruits were followed by swelling of the quadriceps muscles, dark urine, albuminuria, hematuria, pyuria, red blood cell casts, myoglobinuria, and hemoglobinuria. In all 19 patients who were hospitalized albuminuria was demonstrable. Spectrophotometric and chemical study of dark urine specimens from these persons revealed excretion of both myoglobin and hemoglobin. Renal biopsy specimens of two patients, one of whom experienced acute renal failure, disclosed tubular abnormalities compatible with acute tubular necrosis. After recovery, resumption of the same calisthenics did not cause reappearance of renal or muscular symptoms.
Howenstine JA. EXERTION-INDUCED MYOGLOBINURIA AND HEMOGLOBINURIASIMULATION OF ACUTE GLOMERULONEPHRITIS. JAMA. 1960;173(5):493–499. doi:10.1001/jama.1960.03020230019005