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Just seen [url= http://www.medscape.com/viewarticle/883459?nlid=117414_1842&src=WNL_mdplsfeat_170822_mscpedit_wir&uac=67310HR&spon=17&impID=1416333&faf=1 ]THIS[/url] (I assume anyone can view it - I don't think it's super-new thinking but is attempting to explain an apparent big rise in severe damage & deaths):
Workers exerting themselves and dehydrating in hot climates (and possibly drinking sugary drinks) are suggested to experience repeated brief episodes of kidney failure, leading ultimately to ... bad shit
Presumably much of this putative mechanism miht be similar in those exerting themselves for pleasure