Advances in Physical Education
2012. Vol.2, No.3, 103-109
Published Online August 2012 in SciRes (http://www.SciRP.org/journal/ape) http://dx.doi.org/10.4236/ape.2012.23019
Renal Responses to a Series of Handball Games Played in
Sub-Saharan Environment by Amateur Division 1 of
Female Players
Brigitte Affidéhomé Tonon1, Bruno Agboton2,3, Jean-Marie Falola1, Polycarpe Gouthon1*,
Issiako Bio Nigan1, Edgard-Marius Ouendo4, Hippolyte Agboton5,
Jacques-Rémy Poortmans6
1Laboratory of Physical and Sportive Activities and Motility, National Institute of Youth,
Physical Education and Sport, University of Abomey-Calavi, Porto-Novo, Republic of Benin
2Department of Nephrology, National Hospital of Cotonou, Cotonou, Republic of Benin
3Faculty of Health Science, University of Abomey-Calavi, Cotonou, Republic of Benin
4Regional Institute of Public Health/WHO, University of Abomey-Calavi, Ouidah, Republic of Benin
5Unity of Formation and Research in Cardiology, Faculty of Health Science,
University of Abomey-Calavi, Cotonou, Republic of Benin
6Faculty of Motility Sciences, University of Brussels, Brussels, Republic of Belgium
Received April 21st, 2012; revised May 19th, 2012; accepted June 4th, 2012
This study aims at assessing the modifications of renal parameters with 13 female players of the same
Benin team-amateur Division 1, during two consecutive handball games played 26 hours apart. The play-
ers are divided into two groups: starters (ST: N = 7) and nonstarters (NS: N = 6). The estimated glomeru-
lar filtration rate (eGFR) with Cockcroft-Gault and MDRD formulas, the fractional excretion of sodium
(FeNa), the plasma haemoglobin (Hb) and albumin (Alb) were assayed at rest and at the end of each game.
At the end of the first game, only eGFR decreased significantly by at least 16.30% (p < 0.05) in ST only.
At the end of the second game, the average reductions of eGFR are significant in both the ST and NS
groups (p < 0.05), but they are less important than those recorded at the end of the first (p > 0.05). FeNa
varied in no group, neither after the first game, nor after the second (p > 0.05). But a cumulative reduction
is observed between the values before the first and those recorded at the end of the second game in both
ST and NS groups. The status of the players (ST or NS) did not influence the results. Two games of
handball played 26 hours apart in the sub-Saharan environment of Cotonou caused in girls, a transitory
decrease in eGFR without a cumulative effect. FeNa decreased too, but with a cumulative effect which
indicates large sodium retention.
Keywords: Renal Function; Handball; Girls; Hot Environment; Benin
Introduction
The transition from resting to physical exercise may cause
benign or pathological modifications in different organs par-
ticularly in the kidneys, because of the redistribution of the
cardiac output to active muscles (Goffin & Nielsens, 2006).
This induces a decrease in renal blood flow, in accordance with
the exercise intensity, and consequently a transitory deteriora-
tion in the renal hemodynamic as well as a stimulation of the
electrolytes and proteins excretion (Poortmans, 1995). Works
on the interaction between exercise and kidney are scarce and
most of them were undertaken in developed countries with
moderate climate (Lippi, Banfi, Salvagno, Franchini, & Guidi,
2008b; Poortmans & Ouchinsky, 2006). The majority of studies
related to renal function, undertaken in Africa and particularly
in developing countries, were about the epidemiological aspects
of renal affections (Naicker, 2009; Gnionsahe, Lagou, & Tia,
2007). Moreover, most of the data about renal adaptations to
exercise, relate to individual sports practitioners, especially the
males (Afshar, Sanavi, & Jalali Nadooshan, 2009; Lippi et al.,
2008a), so that information on the game sports and the sports-
women is scarce. One of the recent studies on renal adaptations
to exercise carried out in African tropical environment concerns
the effects of a basketball game on the renal parameters (Gouthon
et al., 2009). In spite of the transitory character of renal dys-
function highlighted by the authors of the latter study, it is
critical to know the mode of adaptation of the kidneys to physical
burden resulting from a series of games played in a competition
period. That is more especially needed in game sports, particu-
larly in the field of African handball, in which the competitions
are organized as grouped tournaments, with short resting peri-
ods between games.
Handball is a game sport characterized by a playing intensity
which increases the heart rate to 85% of its maximum value and
a high level of physical commitment indicated by frequent at-
tacker-defender duels, as well as very short and explosive ac-
tions, like ball throws (Buchheit, 2005). All these characteris-
tics suggest that a handball game exerts strong constraints on
the whole functions which contribute to homeostasis, particu-
larly on renal function, especially when the game takes place in
hot and humid sub-Saharan environment like that of Cotonou in
*Corresponding author.

B. A. TONON ET AL.
the South of the Republic of Benin.
This environment is indeed characterized in the daytime by
an ambient temperature which varies between 29˚C and 34˚C
and a relative humidity between 70% and 90% (Encarta, 2008),
likely to induce high levels of dehydration and damage to the
sportsmen health.
In such a context, the players often participate in two or three
consecutive games approximately 24 hours apart, being thus
exposed to a physical and thermal stress. The possible renal
dysfunctions recorded after a handball game on the most solic-
ited players that are starters, are currently ignored, as well as
the effects of a second game played without a sufficient rest.
This study consequently aims at comparing in starters and
nonstarters of the same team, the modifications of the renal
parameters during a series of two handball games, played in the
sub-Saharan environment of the Republic of Benin.
Material and Methods
Study Sample
This is a casual comparative study, carried out in December
2009 in Cotonou (Republic of Benin, West Africa), with female
handball players involved in the preliminary stages of the na-
tional championship of the amateur-Division 1. The non-proba-
bilistic study sample is composed of 13 senior voluntary play-
ers out of among the 14 available at the beginning of the tour-
nament (age: 25.6 ± 5.7 years; weight: 56.4 ± 6.0 kg; height:
165.6 ± 5.3 cm; BMI: 20.5 ± 2.0 kg/m2). The starters’ group
(ST: N = 7) is composed of players entering on the playground
at the first half-time, during each of the first two games of the
tournament, whereas the nonstarters’ group (NS: N = 6) is formed
of a while other girl players or non-players of the two games.
Criteria of Inclusion
The criteria of inclusion in the study sample are as follows:
be a black player; be a resident in Benin at least a year ago
because of feeding habits; be 18 years old or more, i.e. being a
player of the senior team retained for the study; give one’s
written and informed consent to take part in the study.
Criteria of Non-Inclusion
Any player under anti-hypertensive, anti-malarial treatment
or anti-inflammatory drug or under any other treatment likely to
influence the renal parameters was excluded. There was one
under non-steroidal anti-inflammatory drug (NSAID). So she
was excluded from the study.
Measurements and Study Variables
The distance covered during the games was measured using
Manuel Y-2028 (Géonaute Decathlon, China) podometers. EDTA
tubes (for blood hemoglobin and hematocrit) and dry tubes (for
creatinine, albumin, and electrolytes) are used per player, to
take 10 mL of blood sample. Dry tubes were used to take 10
mL of urine per player for creatinine and electrolytes assays.
Graduated tubes (10 to 1500 mL) were used to measure the
quantity of water drunk by the players at the end of each game.
A spectrophotometer RT-9200 (Rayto, Germany) was used for
assaying blood and urinary creatinine, as well as plasma albu-
min. Sodium and potassium were assayed by photometry with
electrons of reference, with an Electrolyte Analyser ISE 4500
(Sfri, France). Blood hemoglobin and the hematocrit rate were
determined using an automated Counter M-Series (Medonic,
Sweden).
The estimated glomerular filtration rate (eGFR) was calcu-
lated using plasma creatinine in the formula of Cockcroft-Gault
(C-G) (Cockcroft & Gault, 1976) normalized and that of MDRD
(Levey et al., 2006). The glomerular function is considered al-
tered for any value of eGFR lower than 90 mL/min/1.73m2. The
fractional excretion of sodium


  
  
FeNa
urine sodiummmolLplasmacreatininemgdL
100 plasma sodiummmolLurine creatininemgdL

 
was also calculated (Carvounis, Nisar & Guro-Razuman, 2002).
For these authors and in this study, a FeNa resting value lower
than 1% suggests an acute functional renal insufficiency and a
value higher than 2% indicates an acute tubular necrosis, two
functional acute renal failures.
The plasma hemoglobin, creatinine and albumin were deter-
mined by traditional techniques of clinical biology, i.e. respect-
tively with automated Counter, by the colorimetrical technique
(Jaffé, 1886) and that of final point (Pinnell & Northam, 1978).
Plasma hemoglobin (Hb) and albumin (Alb) respectively lower
than 12 g/100mL and higher than 52 g/L (Janssens, 2009) were
considered abnormal, i.e. jointly associated with anemia and
dehydration.
At the end of each game and during the recovery, the varia-
tion of plasma volume (ΔPV) was calculated using the follow-
ing formula:




PV%100Hbbefore Hbafte
1Hematocritafter 100
100
1Hematocritbefore 100
r

 




 



In this formula, Hbbefore and Hematocritbefore represent re-
spectively plasma resting (before the game) Hb and Hematocrit,
then Hbafter and Hematocritafter, those measured at the end of
the game (Dill & Costill, 1974).
Study Desi gn
The day before the first game, all the 13 players (starters and
nonstarters) filled out a questionnaire addressing their sports
practice, personal history of cardiovascular and renal diseases
and their menstrual status. On the first day, measurements were
taken before the warm up of the players registered for the game.
After a 20 min-warm up, each game was played in full time, i.e.
30 min × 2 with a 15 min-break (International Handball Fed-
eration, 2010). Just at the end of the game, the second meas-
urements were taken and the total quantity of water drunk by
the girls was assessed. The second game was played by the
same girls 26 hours later, according to the tournament schedule.
The same operations and procedures of measurements were taken
again with the second game. Figure 1 shows the chronological
order of blood sampling and urine taking throughout the study.
The blood samples were taken from an antecubital vein of
the left elbow of the players and assayed as well as the urine
taken, within two hours, after storage in a refrigerator. The
podometers were programmed and read by evaluators accus-
tomed to their use. During and after the games, the girls were
104

B. A. TONON ET AL.
Game 1
(G1)
2 hours before game 1.
Biometric measures
Game 2
(G2)
Second day
Recovery: 26 hours
First day
25 min before
game 1 Blood
Urine
25 min before
game 2 Blood
Urine
End G2 Blood
Urine
End G1 Blood
Urine
G1: first game; G2: second game.
Figure 1.
Schematic representation of the study design.
14th days) and six girls out of 13 among whom three ST players
were in premenstrual or secretory phase (17th to 23rd days).
authorized to drink ad libitum water containing (in mg/L) Na+ =
5.8; K+ = 0.4; Cl– = 10; Ca++ = 3.1; Mg++ = 1.5; Bicarbonates =
9.8; Sulfates = 1.2; Nitrates < 3. The last training session of the
girls took place 48 hours before the first game and each time,
the last meal was consumed at least four hours before the be-
ginning of the game.
The games were played in-door under a temperature and a
relative humidity varying respectively between 32˚C and 35˚C,
then 62% and 63%. The experimental team won the first game
by 26 goals against 24, but they lost the second one, by 18
goals against 21. In the ST group, each player covered on av-
erage 3603 ± 2411 m during the first game, 3598 ± 1108 m
during the second one, and drank firstly on average 923 ± 393
mL and 909 ± 343 mL during the second game. In the NS group,
each player covered on average 1342 ± 945 m during the first
game, 929 ± 899 m for the second, and then drank on average
574 ± 370 mL during the first game and 476 ± 520 mL for the
second one. In the ST and NS groups, respective reductions of
8.9% ± 8.1% and 12.8% ± 6.2% of the PV were recorded at the
end of the first game, against 0.8 ± 6.1% and 4.9 ± 6.6% at the
end of the second one. A reduction of 10.0% ± 9.8% of the PV
was recorded in the ST group (p > 0.05) against 8.2% ± 8.1% in
NS (p < 0.05). At the end of each game, significant differences
appear between the ST and NS groups with regard to the dis-
tance covered (p = 0.038 for the first game and p = 0.0042 for
the second one). The NS players drank significantly less than
the ST ones, during the second game (p = 0.045).
Ethical Considerations
A week before the games, all the players were informed of
the objective, the procedure of the study, the data confidential-
ity, the safety dispositions, as well as incurred possible risks,
before giving their written informed consent. The study was
approved by the Sports Science Council (named CSS/STAPS)
of the University of Abomey-Calavi, acting as the ethic committee.
Statistical Analysis
The data were processed with the software Statistica (Stat
Soft Inc., Version 8.0). Descriptive statistics: mean values (M),
standard deviation (S) were calculated for each variable studied.
The normal distribution of the variables was checked, using the
test of Kolmogorov-Smirnov. A two-factor analysis of variance
(Anova) was undertaken to check the interaction (Ti me of mea s-
urement x Status). A one factor Friedman Anova was used to
test the time of measurement effect. In case of significant Anova,
the multiple comparison tests: the post hoc test of Tukey, the
test of Wilcoxon or the U of Mann Withney test was applied,
depending on the case. The level of significance of all statistical
tests was set at p < 0.05.
At rest, none of the players has the plasma Alb higher than
52 g/L and there was not a significant difference between the
ST and NS players (p > 0.05).
Evolutio n of the Renal Parameters during the Games
In the ST group, the eGFR according to C-G and MDRD de-
creased respectively by 16.30% (p = 0.017) and by 18.87% (p =
0.017) at the end of the first game, then increased by 18.30% (p
= 0.017) and by 21.69% (p = 0.017) 26 hours later, without
reaching the resting value. It then decreased by 14.92% (p =
0.017) for C-G and by 16.97% (p = 0.017) for MDRD at the
end of the second game (Figures 2 and 3). In the NS group, the
eGFR did not vary at the end of the first game (p > 0.05) but it
increased 26 hours later (C-G: 13.74%, p = 0.043; MDRD:
15.87%, p = 0.043) before decreasing at the end of the second
one (C-G: 11.99%, p = 0.027; MDRD: 13.69%, p = 0.027).
Results
Biometric Characteristics, Menstrual Status of the
Players and Game Data
The players involved in the study are 25.6 ± 5.7 years old (19
- 37 years), trained on average 5 ± 1 hours per week, for 10 ± 5
years. Whatever the biometric variable considered, no signifi-
cant difference (p > 0.05) appears between the ST and NS (Ta-
ble 1). None of the players has a history of arterial hypertension
and/or renal disease. Three girls out of 13, among whom one
ST were in menstrual phase (first to second days), four players
out of 13 among whom three ST were in follicular phase (6th to
At the end of the first game, the variations of eGFR recorded
in the ST group are higher than those observed in NS (C-G, p =
0.045; MDRD, p = 0.045). When the two games are taken together,

B. A. TONON ET AL.
Table 1.
Biometric characteristics of the handball female players studied (N = 13).
Age (years) Height (m)Weight (kg)BSA (m2)BMI (kg/m2)RHR (bpm)
ST (N = 7)25.8 ± 6.4 1.6 ± 0.6 56.3 ± 6.0 1.6 ± 0.120.6 ± 2.076 ± 13
NS (N = 6) 25.5 ± 5.0 1.6 ± 0.4 56.5 ± 6.6 1.6 ± 0.120.4 ± 2.274 ± 10
Values in the cases are means (M) ± standard deviations (SD); ST: starters; NS: nonstarters; N: sample size;
BMI: body mass index; BSA: body surface area; RHR: resting heart rate.
0
20
40
60
80
100
120
Starters Nonstarters
Estimated Glomerul ar filtratio n
rate of C-G (mL/min/1.73 m
2
)
Measure 1: At rest
Measure 2: End of game 1
Measure 3: Begin game 2
Measure 4: End of game 2
**‡
††‡
The bars on the histogram represent standard deviation (SD); C-G: Cockcroft and Gault (1976); *difference
with Measure 1, significant at p < 0.05; †difference with Measure 2, significant at p < 0.05; ‡difference with
Measure 3, significant at p < 0.05.
Figure 2.
eGFR with the Cockcroft and Gault formula (1976) standardized, in the studied players dur-
ing the two games. Interaction (time of measurement × status), p < 0.0001; Anova for time of
measurement, p = 0.0021 (Starters), p = 0.064 (Nonstarters).
0
20
40
60
80
100
120
Starters Nonstarters
Estimated glomerular filtration rate
with MDRD (mL/min/1.73 m
2
)
Measure 1: At re st
Measure 2: E nd of game 1
Measure 3: Be gin game 2
Measure 4: E nd of game 2
*
†
*‡
†‡
The bars on the histogram represent standard deviation (SD); MDRD: Modification of Diet in Renal Dis-
ease equation of Levey et al. (2006); *difference with Measure 1, significant at p < 0.05; †difference with
Measure 2, significant at p < 0.05; ‡difference with Measure 3, significant at p < 0.05.
Figure 3.
eGFR with MDRD equation (Levey et al., 2006) in the studied players during the two games.
Interaction (time of measurement × status), p < 0.0001; Anova for time of measurement, p =
0.0021 (Starters), p = 0.064 (Nonstarters).
the modifications of eGFR recorded do not present a significant
difference compared to those recorded at the end of the first
game, in the ST group (p = 0.86 for C-G and MDRD) as well as
in NS (p = 0.71 for C-G and MDRD). The eGFR standard de-
viations appear more significant in the NS group than in ST,
irrespective of the formula used (Figures 2 and 3).
The FeNa did not vary significantly in the two groups (ST
and NS) neither at the end of the first game, nor at the end of
the second one (Figure 4). During the 26 hours which followed
the end of the first game, FeNa decreased in the two groups (ST:
85.43%, p = 0.026; NS: 88.88%, p = 0.015). At the end of the
second game, the reductions of FeNa recorded in the two groups
106

B. A. TONON ET AL.
0
0,2
0,4
0,6
0,8
1
1,2
1,4
Starters Nonstarters
Fractional excretion of sodium (%)
Measure 1: At rest
Measure 2: End of game 1
Measure 3: Begin game 2
Measure 4: End of game 2
**
†
†
*
*
†
**
†
The bars on the histogram represent standard deviation (SD); *difference with Measure 1, significant at p <
0.05; **difference with Measure 1, significant at p < 0.01; †difference with Measure 2, significant at p <
0.05.
Figure 4.
FeNa in the studied players during the two games. Interaction (time of measurement × status),
p < 0.0001; Anova for time of measurement, p < 0.001 (Starters), p < 0.01 (Nonstarters).
are more significant than those obtained at the end of the first
one (ST: 0.68 ± 0.49% versus 0.18 ± 0.21%, p = 0.017) and
(NS: 0.51 ± 0.24% versus 0.00005 ± 0.27% p = 0.027), without
presenting however significant difference between them (p >
0.05). At rest, the standard deviations are more significant in
the NS group than in ST, whereas the opposite phenomenon is
observed at the end of the games.
Discussion
This study produced innovative experimental results, primar-
ily in relation to renal function of the African populations in-
volved in physical activities in sub-Saharan environment. Our
investigation was carried out in the competition period, during
the preliminary stages of handball championship (Division 1) in
Benin, with the team of amateur senior-players who took up the
fourth position for qualification to the final phase.
The majority of the girls (77%) were in post-menstrual pe-
riod, i.e. in follicular or secretory phase. The first phase which
induces an increase in the plasma estrogen concentration can
favor water retention and deeply alter the sodium and potas-
sium excretion (Pitkin, Reynolds, Williams & Hargis, 1978).
The increased plasma progesterone concentration often observed
during the secretory phase impacts on the aldosterone, which
can culminate in a high sodium excretion (Szmuilowicz et al.,
2006). It does not seem to be the case in our series, since a re-
duction of the fractional sodium excretion was recorded, during
the 26 hour-recovery period.
The temperature and the relative humidity recorded during
the games suggest that the girls made an effort under a high
thermal stress likely to disturb their central cardiovascular ad-
aptation (heart) as well as the peripheral one (muscles, skin). In
fact, during a physical exercise in a hot and humid environment
like that of this study, the thermal stress can induce an increase
in core temperature, tiredness and a risk of accident, resulting
from the dehydration caused by sweat losses (Koulmann, Ban-
zet & Bigard, 2003).
The high standard deviations observed on the distance covered
by the starters, account for the heterogeneity of the group re-
garding their participation in the game, since real play times are
unequal. They can justify the high variations observed with
regard to the eGFR according to the two formulas used.
The absence of significant difference in the variation of the
plasma volume between the two groups (starters and nonstarters),
from the beginning of the first game to the end of the second
(–10% and –8%, p = 0.77), though the starters drank during the
second game more than the nonstarters, is probably in relation
to the hydration level of the players during the games. This
hydration level can be regarded as less compensatory in hot and
humid environment, when compared with the recommendations
in the literature (Casa et al., 2000; American College of Sports
Medicine, 1996). The volume of water drunk on average by the
girls before (250 mL) and after each game, though partially in
conformity with the recommendations in starters, did not con-
tribute to avoid the decrease of plasma volume in these players.
The weak rate of plasma hemoglobin (Hb < 12 g/100mL)
noted in all the girls of the two groups of our series, could be
associated with a nutritional deficiency and/or malaria or intes-
tinal parasites. As a matter of fact, anemia in black African
subjects usually results from combination between nutritional
deficiency, iron losses due to intestinal parasites, hemolysis
caused by malaria infections and genetic factors (Nussenblatt &
Semba, 2002). The menstrual blood loss and the worsening of
the renal function constitute other factors which may induce an
abnormal decrease of plasma hemoglobin in these post-pubescent
girls. Some authors have also reported a high prevalence of ane-
mia in their series of female basketball players in Benin (Gouthon
et al., 2009) and in white Italian young fertile non-professional
female athletes (Di Santolo, Stel, Banfi, Gonano, & Cauci, 2008).
One can notice that, some reports did not reveal abnormal plasma
Hb in female cyclists (Schumacher, Pottgiesser, Ahlgrim, Ruthardt,
Dickhuth, & Roecker, 2008; Sims, Rehrer, Bell, & Cotter, 2007).
Since the values before the preparation of the competition are
not available, the assumption of pseudo-anemia could not be
completely isolated when explaining the high prevalence of
weak plasma Hb in this study.

B. A. TONON ET AL.
On one hand, the reference values of plasma albumin (32 to
58 g/L) proposed by Bigot et al. (1996) for the non-sporting
Benin population and those suggested by Janssens (2009) for
Europeans population (35 to 52 g/L), help to assert that no
player was dehydrated at the beginning of this study. On the
other hand, if one refers to the usual values (from 33 to 45 g/L)
reported for the general female population in Europe (Burtis,
Ashwood & Bruns, 2005), or to the mean value (41 g/L) found
in Africa (Adéwoye & Fawibe, 1978), 87.5% of the female
players involved in this study should be regarded as dehydrated
at rest. This divergence in the available data suggests the need
for establishing in short term, the specific standards for the
sporting population in the Republic of Benin, even in sub-Saharan
Africa.
The disparities in the renal responses recorded during the
games are to be associated to the inequality in the real playing
time of the starters, since at rest a relative homogeneity was
observed, drawing aside thereby the influence of their sporting
practice.
The main cause of the reduction of eGFR after each game
would be in relation to the decrease in the renal blood flow in
favor of the active muscles (Goffin & Nielsens, 2006). The
reductions of these parameters recorded at the end of the first
game are however transitory, since 26 hours later, the tenden-
cies were reversed. These phenomena observed in the present
study and reported by different authors (Gouthon et al., 2009;
Lippi et al., 2008b) are well-known. In fact, the pre-cited au-
thors recorded a transitory decrease in the clearance of creatinine
at the end of a basketball game, while the latters observed a
reduction of eGFR at the end of a semi-marathon of 21 km. In
another study (Lippi et al., 2008a), it has been recorded an in-
crease in eGFR after a cycling test, whereas another author
(Poortmans, Jourdain, Heyters & Reardon, 1990) did not ob-
serve any significant modification of the values of this parame-
ter after a rowing test. The divergence between our results and
those of the latter authors could be mainly associated to hydra-
tion status or to differences in exercise intensity in the studies.
It appeared that the second handball game did not exert a cu-
mulative effect on the eGFR in the players of this study. The
abnormally reduced sample size, as well as the 26 hour-recovery
between the two games could influence negatively the results of
statistical tests and renal responses.
The standard deviations, less significant in the starters’ group
compared to that of the nonstarters show a less inter-individual
variation and probably indicate a relative homogeneity of the
starters’ group, with regard to the renal response to the effort.
The reduction of FeNa in both the starters and nonstarters’
groups at the end of the two games, could be attached to the
decrease of plasma volume (Carvounis et al., 2002) resulting
from the sudation caused by the high thermal stress in the
sports hall, as well as the tubular reabsorption stimulated jointly
by an increased production of vasopressin and aldosterone, both
induced by intense exercise (Sims et al., 2007).
The variations of FeNa recorded could also be associated
with an inadequate hydration in the players of the two groups
during the 26 hour-recovery period. This phenomenon has been
already reported in sportsmen (Yeargin et al., 2010). The effect
of vasopressin and aldosterone lasts from 12 to 48 hours after
the exercise (Brooks & Mercier, 1994). Unlike the observations
relating to the two parameters of eGFR, a cumulative effect of
the two games was observed on FeNa. The values lower than
1% recorded suggests the occurrence of a transitory renal func-
tional insufficiency in these female handball players. FeNa is
indeed generally lower than 1% in subjects suffering from acute
glomerulonephritis, hepato-renal syndrome and any cause of
renal functional insufficiency like severe congestive cardiac
insufficiency, incomplete and acute obstruction of the urinary
tracts or dehydration (Fesler, 2007). The decrease in FeNa,
some hours after the effort, is in conformity with the literature
data (Gerth et al., 2002; Irving, Noakes & van Zyl-Smit, 1989).
The results of this study support the idea according to which
a series of two handball games played in hot and humid envi-
ronment by the girls of Benin elite does not deteriorate to a
significant degree the glomerular function. Then the data col-
lected help to think that the competitive continuation of hand-
ball practice can be recommended to these players, since they
are subjected to a balanced diet. This intake dietary may help to
normalize their plasma hemoglobin values and to ensure hy-
dro-mineral balance after one, even two games played 24 to 36
hours apart, as it is often the case in the official competitions in
Africa.
Study Limits
Since the players’ dietary including intake water may affect
the glomerular filtration rate (eGFR) and the fractional excre-
tion of sodium (FeNa), we would like to assess it in this study,
but we could not do it accurately, because they use to take their
meals individually at home or in restaurants at the edge of roads.
Although these data will be very useful to explain the results,
data collected in such conditions may not be reliable. The con-
clusions of the study are also limited to only women, since only
female players took part of it. Their team was indeed the only
one playing at the handball Division 1 level in Porto-Novo, the
town where the study was carried out.
Conclusion
The group of the studied female players evoked a state of be-
nign anemia. The assumption according to which playing a
second handball game in the hot and humid environment of the
sport hall of Cotonou, only 26 hours after the first, causes an
additional deterioration of the renal glomerular function, is not
confirmed. The only renal parameter for which a cumulative
effect was highlighted is the FeNa. It seems useful to carry on
this study with a more significant series of games (four to six),
in order to validate the absence of more significant disturbance
of renal function. It is indeed an issue of keeping safely the
current formulae of Benin handball championship (Division 1)
organization, arranged in two phases in forms of grouped tour-
naments: the preliminary with five games and the final with at
least three games per team in five days.
Acknowledgements
The authors are indebted to the managers of the Centre of
Muscular and Cardiovascular Maintenance VITAFORME of
Porto-Novo (Republic of Benin), for their technical support
during data processing and analysis, as well as the final prepa-
ration of the manuscript.
REFERENCES
Adéwoye, H. O., & Fawibe, J. F. (1978). Serum albumin level in an
108

B. A. TONON ET AL.
urban Nigerian population. British Journal of Nutrition, 40, 439-442.
doi:10.1079/BJN19780145
Afshar, R., Sanavi, S., & Jalali Nadooshan, M. R. (2009). Urinary so-
dium and potassium excretion following karate competitions. Iran
Journal of Kidney Disease, 3, 86-88.
American College of Sports Medicine (1996). Position stand on exer-
cise and fluid replacement. Medicine and Science in Sports and Ex-
ercise, 28, 1-7.
“Bénin” Encyclopédie Microsoft® Encarta® (2008). URL (Last checked
10 January 2010). http://fr.encarta.msn.com
Bigot, A., Akpona, S., Attolou, V., Avodé, G., Djrolo, F., Houngbè, F.,
Fatoke, M., & Zohoun, I. (1996). Valeurs de référence de 11 pro-
téines sériques dans une population apparemment en bonne santé.
Journal de la Socié té de Biologie Clinique (Bénin), 3, 45-48.
Brooks, G. A., & Mercier, J. (1994). Balance of carbohydrate and lipid
utilization during exercise: The ‘‘crossover’’ concept. Journal of Ap-
plied Physiology, 76, 2253-2261.
Buchheit, M. (2005). Connaissances adultes. Le 30-15 Intermittent Fit-
ness Test: Illustration de la programmation du travail de la puissance
maximale aérobie à partir d’un test de terrain approprié. Approches
du Handball, 88, 36-46.
Burtis, C. A., Ashwood, E. R., & Bruns, D. E. (2005). Tietz textbook of
clinical chemistry and molecular diagnostics (4th ed.), Paris: Elsevier
Saunders.
Carvounis, C. P., Nisar, S., & Guro-Razuman, S. (2002). Significance
of the fractional excretion of urea in the differential diagnosis of ac-
ute renal failure. Kidney International, 62, 2223-2229.
doi:10.1046/j.1523-1755.2002.00683.x
Casa, D. J., Armstrong, L. E., Hillman, S. A., Montain, S. J., Reiff, R.
V., Rich, B. S. E., Roberts, W. O., & Stone, J. A. (2000). National
athletic trainers’ association position statement: Fluid replacement
for athletes. Journal of Athletic Training, 35, 212-224.
Cockcroft, D. W., & Gault, H. M. (1976). Prediction of creatinine clear-
ance from serum creatinine. Nephron, 16, 31-41.
doi:10.1046/j.1523-1755.2002.00683.x
Dill, D. B., & Costill, D. L. (1974). Calculation of percentage changes
in volumes of blood, plasma, and red cells in dehydration. Journal of
Applied Physiology, 37, 247-248.
Di Santolo, M., Stel, G., Banfi, G., Gonano, F., & Cauci, S. (2008).
Anemia and iron status in young fertile non-professional female ath-
letes. European Journal of Applied Physiology, 102, 703-709.
doi:10.1007/s00421-007-0647-9
International Handball Federation (IHF) (2010). International handball
federation rules. Basel: IHF.
Fesler, P., & Mimran, A. (2007). Ionogramme urinaire de 24 heures:
Comment l’interpréter? Journal de Néphrologie-Cardiologie, 18.
Gerth, J., Ott, U., Fünfstück, R., Bartsch, R., Keil, E., Schubert, K.,
Hübscher, J., Scheucht, S., & Stein, G. (2002). The effect of pro-
longed physical exercise on renal function, electrolyte balance and
muscle cell breakdown. Clinical Nephrology, 57, 425-431.
Gnionsahe, D. A., Lagou, D. A., & Tia, W. M. (2007). Prevalence of
acquired cystic disease in Black Africans on hemodialysis in West
Africa. Saudian Journal of Kidney Disease and Transplantation, 18,
114-116.
Goffin, E., & Nielsens, H. (2006). Peut-on pratiquer un sport lorsqu’on
est insuffisant rénal chronique, dialysé ou transplanté? AIRGFrance:
Information Medicale 2006. URL (Last checked 1 July 2009).
http://www.airg-france.org
Gouthon, P., Tonon, B. A., Ouendo, E.-M., Falola, J.-M., Agboton, B.,
Dansou, H. P. & Poortmans, J. R. (2009). Evolution des paramètres
associés à la fonction rénale après un match de basketball en milieu
africain subsaharien. Science & Sports, 24, 293-301.
doi:10.1016/j.scispo.2009.03.004
Irving, R. A., Noakes, T. D., & van Zyl-Smit, R. (1989). Metabolic and
renal changes in two athletes during a world 24 hours relay record
performance. British Journal of Sports Medicine, 23, 227-232.
doi:10.1136/bjsm.23.4.227
Jaffé, N. (1886). Ueber den neiderschlag, welchen pikrinsaeure in nor-
malen harn erzeugt un über eine neue reaktion des kretinins. Zeit-
schrift für Physiologische Chemie, 10, 391-400.
Janssens, G. (2009). Répertoire d’analyses de biologie clinique [on
line]. 3rd Edition, Brussels. URL (Last checked 22 December 2010).
www.ulb-ibc.be/Repertoire_IBC_2009_2.pdf
Koulmann, N., Banzet, S., & Bigard, A. X. (2003). L’activité physique
à la chaleur: De la physiologie aux recommandations d’apport hy-
drique. Medecine Tropicale, 63, 617-626.
Levey A. S, Coresh J., Greene T., Stevens L. A., Zhang Y. L., Hend-
riksen S., Kusek, J. W., & Van Lente, F. (2006). Chronic kidney di-
sease epidemiology collaboration. Using standardized serum creatin-
ine values in the modification of diet in renal disease study equation
for estimating glomerular filtration rate. Annals of Internal Medicine,
145, 247-254.
Lippi, G., Schena, F., Salvagno, G. L., Tarperi, C., Montagnana, M.,
Gelati, M., Banfi, G., & Guidi, G. C. (2008a). Acute variation of es-
timated glomerular filtration rate following a half-marathon run. In-
ternational Journa l of Sports Medicine, 29, 948-951.
Lippi, G., Banfi, G., Salvagno, G. L., Franchini, M., & Guidi, G. C. (2008b).
Glomerular filtration rate in endurance athletes. Clinical Journal of
Sport Medicine, 18 , 286-288. doi:10.1097/JSM.0b013e31817049c5
Naicker, S. (2009). End-stage renal disease in sub-Saharan Africa. Eth-
nicity Disease, 19, 13-15.
Nussenblatt, V., & Semba, R. D. (2002). Micronutrient, malnutrition
and the pathogenesis of malarial anemia. Acta Tropica, 82, 321-337.
doi:10.1016/S0001-706X(02)00049-9
Pinnell, A. E., & Northam, B. E. (1978). New automated dye-binding
method for serum albumin determination with bromocresol purple.
Clinical Chemistry, 24, 808-806.
Pitkin, R. M., Reynolds, W. A., Williams, G. A., & Hargis, G. K. (1978).
Calcium regulating hormones during the menstrual cycle. Journal of
Clinical Endocrinology a n d Metabolism, 4 7 , 626-632.
doi:10.1210/jcem-47-3-626
Poortmans, J.-R., & Ouchinsky, M. (2006). Glomerular filtration rate
and albumin excretion after maximal exercise in aging sedentary and
active men. The Journals of Gerontology Series A: Biological Sci-
ences and Medical Sciences, 61, 1181-1185.
doi:10.1093/gerona/61.11.1181
Poortmans, J.-R. (1995). La réponse rénale à l’exercice chez le sujet
sain et pathologique. Nephrology, 16, 317-324.
Poortmans, J.-R., Jourdain, M., Heyters, C., & Reardon, F. D. (1990).
Postexercise proteinuria in rowers. Canadian Journal of Sport Sci-
ence, 15, 126-130.
Schumacher, Y. O., Pottgiesser, T., Ahlgrim, C., Ruthardt, S., Dickhuth,
H.-H., & Roecker, K. (2008). Haemoglobin mass in cyclists during
stage racing. International Journal of Sports Medicine, 29, 372-378.
doi:10.1093/gerona/61.11.1181
Sims, S. T., Rehrer, N. J., Bell, M. L., & Cotter, J. D. (2007). Preexer-
cise sodium loading aids fluid balance and endurance for women ex-
ercising in the heat. Journal of Applied Phys io lo g y, 103, 534-541.
doi:10.1152/japplphysiol.01203.2006
Szmuilowicz, E. D., Adler, G. K., Williams, J. S., Green, D. E., Yao, T.
M., Hopkins, P. N., & Seely, E. W. (2006). Rlationship between al-
dosterone and progesterone in the human menstrual cycle. Journal of
Clinical Endocrinology a n d Metabolism, 9 1 , 3981-3987.
doi:10.1210/jc.2006-1154
Yeargin, S. W., Casa, D. J., Judelson, D. A., McDermott, B. P., Ganio,
M. S., Lee E. C, Lopez, R. M., Stearns, R. L., Anderson, J. M., Arm-
strong, L. E., Kraemer, W. J., & Maresh, C. M. (2010). Thermoregu-
latory responses and hydration practices in heat-acclimatized adoles-
cents during preseason high school football. Journal of Athletic
Training, 45, 136-146. doi:10.4085/1062-6050-45.2.136