An unusual cause of acute kidney injury I recently read about was reported in a recent 2008 issue of C-JASN: glomerular hematuria caused by excessive candombe hand drumming.
Candombe hand drumming is a popular form of music in Uruguay. During a carnival-type festival termed “las llamadas”, several individuals will engage in vigorous hand-drumming for several hours. Interestingly, some individuals will report rust-colored urine, and a subset of these individuals will present with a reduced GFR significant enough to require temporary dialysis. Hematuria in affected individuals tended to show dysmorphic red blood cells, suggesting a glomerular source of hematuria. Furthermore, the mechanism suggested by the authors is extravascular hemolysis as a result of repetitive trauma to the hands as a result of drumming–which is suggested by the elevated post-drumming levels of LDH, low levels of haptoglobin, and relatively normal levels of CK & myoglobin to rule out rhabdomyolysis as a significant contributor to renal injury.