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

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.