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Sports Nephrology: Managing Hypertension, Acute Kidney Injury, and Cardiovascular Risk in a Collegiate Football Player.

Safdar K, Wadlinger R, Kontos CD, Sparks MA. · JACC. Case reports · 2026

This case study describes a college football player with resistant high blood pressure, acute kidney injury, and cardiovascular risk factors, highlighting how standard medical guidelines may not adequately address the unique challenges athletes face due to fluid shifts, dietary trends, and performance demands. The authors argue that a specialized field of sports nephrology—working across sports medicine, cardiology, nutrition, and athletic training—is needed to better manage kidney and heart health in athletes while supporting their performance goals.
Takeaway: Work with sports medicine specialists familiar with kidney health when managing high blood pressure or kidney concerns in athletes, as standard guidelines may not account for the unique stressors of training and competition.
Abstract (source)

Background: Managing hypertension (HTN) and kidney risk in competitive athletes is challenging because of rapid fluid and electrolyte shifts, dietary trends, and performance

Goals: . Case summary A 19-year-old football player presented with resistant HTN, recent hypovolemic acute kidney injury (AKI), and multiple cardiovascular risk factors. Diagnostics included secondary HTN work-up and genetic testing, revealing a single apolipoprotein L1 gene risk allele. Management included minimization of diuretic agents and tailored counseling on sodium and protein intake focused on chronic kidney disease risk, AKI prevention, cardiovascular protection, and performance.

Discussion: Current guidelines offer limited direction for athletes regarding timing and interpretation of kidney biomarkers and return to play or monitoring after AKI. The emerging role of sports nephrology in collaboration with sports medicine, sports cardiology, sports nutrition, athletic trainers, and exercise physiology can address evidence gaps and optimize individualized athlete management for cardiovascular-kidney metabolic syndrome. Take-home messages Standard kidney and HTN guidelines may not fully apply to athletes; balancing health and performance requires nuanced, evidence-informed approaches.

Primary studySports Nutrition & Supplements
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