Blood Pressure Reactivity and Urinary Abnormalities in Young Athletes

BACKGROUND: Urinary abnormalities such as hematuria and proteinuria are occasionally detected in pediatric athletes and are commonly attributed to transient exercise-induced renal stress. However, these findings may also reflect early alterations in cardiovascular regulation, particularly in blood pressure (BP) responses to physical effort. OBJECTIVE: To evaluate the prevalence of urinary abnormalities in young athletes and investigate their association with cardiovascular parameters, with particular focus on hemodynamic response to exercise. METHODS: This retrospective cross-sectional study included 861 pediatric athletes (mean age 13.7 ± 2.1 years) undergoing mandatory pre-participation sports screening. Participants were classified according to the presence (n = 80) or absence (n = 781) of urinary abnormalities. Demographic characteristics, anthropometric measures, urine chemistry, blood pressure and heart rate at rest and after exercise, and echocardiographic findings were compared between groups. RESULTS: Urinary abnormalities were detected in 9.3% of athletes. Hematuria and proteinuria were significantly more frequent in this group (P < 0.001). No differences were observed in age, sex distribution, body mass index, or type of sport practiced. However, athletes with urinary abnormalities showed higher resting diastolic blood pressure (64.9 ± 8.5 vs. 62.7 ± 6.5 mmHg, P = 0.005) and a greater increase in diastolic pressure after exercise both in absolute (ΔDBP: 5.8 ± 10.5 vs. 3.1 ± 9.4 mmHg, P = 0.017) and relative terms (ΔDBP%: 7.8% vs. 4.3%, P = 0.045). No significant differences were observed in heart rate dynamics or echocardiographic findings. CONCLUSIONS: Pediatric athletes with urinary abnormalities exhibited a modest but consistent increase in diastolic BP reactivity to exercise. These findings suggest a modest association between urinary findings and post-exercise hemodynamic adaptation, supporting the integration of cardiovascular assessment into the interpretation of urinary screening results in young athletes.