New Study: Anabolic Steroids & Nutritional Supplements Cause Kidney DamageHughson; Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuildersClinical Kidney JournalVolume 8, Issue 4, 1 AugustAnabolic steroids kidney problems —, https: Renal biopsies steriids acute tubular necrosis. The findings highlight a risk for acute and potentially chronic kidney injury among young men abusing anabolic steroids and using anabolic steroids kidney problems amounts of nutritional supplements. Bodybuilders frequently use anabolic steroids and dietary kieney to acquire strength and body bulk [ 1 ]. The principal nonhormonal supplements are protein, creatine and vitamins [ 2 female facial hair from steroids.
Steroids May Harm Athletes' Kidneys - Renal and Urology News
Hughson; Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders , Clinical Kidney Journal , Volume 8, Issue 4, 1 August , Pages —, https: Renal biopsies revealed acute tubular necrosis. The findings highlight a risk for acute and potentially chronic kidney injury among young men abusing anabolic steroids and using excessive amounts of nutritional supplements.
Bodybuilders frequently use anabolic steroids and dietary supplements to acquire strength and body bulk [ 1 ]. The principal nonhormonal supplements are protein, creatine and vitamins [ 2 ]. The high-protein intake has been of concern to nephrologists because it increases glomerular filtration rates and is experimentally associated with glomerular hyperfiltration and FSGS [ 2 ]. Recent evidence indicates that anabolic steroids are directly toxic to glomeruli and that segmental sclerosis is the result of podocyte loss mediated by apoptosis through a podocyte androgen receptor [ 4 ].
Creatine powder is marketed as a muscle building supplement. Creatine is used by a large number of competitive as well as casual athletes [ 7 ]. The number of reported adverse events is small and usually associated with exercise-induced acute renal failure and rhabdomyolysis during intense training but even with moderate exercise [ 8 ].
We can find three case reports of creatine-associated acute kidney injury not related to rhabdomyolysis [ 9—12 ]. In two patients, kidney injury was associated with acute interstitial nephritis [ 11 , 12 ]. Vitamins are compounded into capsules or tablets containing several times their recommended daily allowances RDA. Some sports nutritionists recommend modest increases of vitamin D over the RDA to — IU a day to enhance bone building [ 13 , 14 ].
A sustained intake of over 50 IU a day can increase serum hydroxyvitamin D levels and cause hypercalcemia with the potential for metastatic renal calcification [ 13 ]. This has occurred as a result of accidental overdoses in hospitalized infants, but the risk of vitamin D toxicity is considered minimal in normal adults [ 14 , 15 ]. The findings are presented to alert nephrologists and general physicians to bodybuilding behaviors that may place young men at risk for kidney injury.
Four bodybuilders were referred to the Hawler University College of Medicine Nephrology Department complaining of weakness and lethargy. Commercial protein and creatine products were used that were imported from the USA. Patient clinical data, duration of weight lifting activity, serum creatinine and MDRD eGFR estimates, serum calcium and estimated daily amounts of supplemental protein, creatine, and vitamin C and vitamin D consumed.
Serum creatinine levels were between Microscopic urinalyses were unremarkable and urine reagent strip testing was negative for glucose, protein, hemoglobin and nitrates. Renal biopsies contained 12 to 16 glomeruli, and all biopsies revealed foci of flattened tubular epithelium with loss of nuclei and epithelial desquamation and blebbing.
The tubulointerstitial deposits were negative with a von Kossa silver stain that reacts primarily with phosphate ions in calcium phosphate deposits. Biopsy findings, Patient 2.
Degenerate and regenerative tubular epithelium is present together with amorphous intratubular calcium-like deposits. Denser interstitial concretions are found in an area of mild interstitial fibrosis and tubular atrophy. No pigmented casts suggesting rhabdomyolysis were identified. In cryostat sections for immunofluorescence microscopy, oxalate crystals as evidence for vitamin C-associated renal oxylosis were not seen by light refraction or by polarization microscopy [ 16 , 17 ].
Serum calcium levels were normal. Biopsy findings, Patient 1. Biopsy findings, Patient 4. A broad area of subcapsular fibrosis and tubular atrophy contains chronic inflammation and obsolescent glomeruli. The inflammation is lymphocytic and considered a nonspecific reaction to cortical atrophy. Protein supplementation consisted of 78— g of whey powder that when added to regular dietary protein including 2—3 L of milk reached — g daily or 3.
The manufacturer recommends no more than 6 g a day for long-term use. One and rarely two daily multi-vitamin tablets were taken. No additional calcium was added to the diet. After the biopsy diagnoses, the patients complied with advice that steroid injections and supplements be discontinued. At 4 weeks, serum creatinine levels were below At 6 months, serum creatinine levels were Random urine collections from all patients demonstrated acidification with a pH of 5—6. None of the patients had any personal or family history of renal stones.
We have examined protein and creatine products sold in local gymnasiums. They have verified shipping documents, and high-pressure liquid chromatography by the regional Quality Assurance Laboratory showed no evidence of adulteration. In addition to patients, we interviewed other bodybuilders at gymnasiums in the region.
They admit the illegal purchase of anabolic steroids but know of no unusual vitamin D use either orally or by injection. Trainers recommend no more than 3—5 g on a regular basis but increased consumption is common.
Trainers favor water for hydration, but colas and energy drinks are preferred by trainees. Four bodybuilders developed acute renal insufficiency while using commercial nutritional supplements consisting of protein and creatine combined with anabolic steroid injections. Biopsies demonstrated acute tubular injury, and when the injections and supplement use were stopped, serum creatinine levels became normal within 4 weeks. The findings raised the possibility of the hypervitaminosis D-induced nephrocalcinosis recently encountered in four Brazilian bodybuilders [ 18—20 ].
Of note was that the injections were not for vitamin D but for the silicone-like effect of the oily carrying medium that was used to add bulk to specific muscle groups. Our findings differ from those of the Brazilians in that none of our patients were hypercalcemic or took large doses of vitamin D, and none of our biopsies could be considered to show nephrocalcinosis. Closely related to hypervitaminosis D is the milk- or calcium-alkali syndrome [ 21—23 ]. This is caused by an excessive consumption of milk or anti-acid calcium carbonate compounds.
Currently, the calcium-alkali syndrome is primarily seen in post-menopausal women taking supplemental calcium and vitamin D for osteoporosis. The occurrence in bodybuilders is not specifically reported apart from hypervitaminosis D, and among our patients, milk and other calcium consumption could not be considered greatly excessive. Acute phosphate nephropathy with intratubular calcium phosphate deposition that somewhat resembles the pathology of our patients is caused by oral sodium phosphates used for bowel preparation before colonoscopy [ 24 ].
Creatine is sold mainly in the form of a monohydrate also with little phosphorus. Daily 2—3 L milk consumption will add 1. This is well below the 11 g oral intake used in bowel preparations [ 24 ]. In addition, the negative von Kossa stains indicates that the mainly amorphous tubular concretions found in the kidneys of our patients were acutely precipitated and had not complexed into crystalline hydroxyapatite with prominently stained phosphates that are seen in hyperphosphatemic nephropathy as well as other forms of neprocalcinosis [ 26 ].
For most athletes, sports nutritionists recommend a daily protein intake of 1. There is substantial experimental and clinical data supporting the safety of creatine supplementation when it is used in the recommended amounts, but there is concern that excess dietary protein and creatine that is not accompanied by increased fluid intake may lead to a relative hypovolemia [ 6—9 ].
The clinical presentation of our three of our patients was in the summer. Iraqi summers are very hot, and by Western standards, the regional gymnasiums are warm and trainee hydration less than optimal.
In previously reported cases of acute kidney injury in creatine users, one demonstrated acute tubular necrosis, but two were classified as acute interstitial nephritis suggesting idiosyncratic allergic reactions [ 10—12 ].
Our patients' biopsies showed acute tubular necrosis that could be nephrotoxic or ischemic [ 28 , 29 ]. In either case, this type of kidney injury among otherwise healthy young men is a rare event and points to a causal relationship with supplement and steroid use.
Two of our patients had significant chronicity in their renal biopsies. This raises the possibility of preexisting chronic kidney disease that may or not be related to supplement use, but more likely reflects the risk that acute kidney injury of any type carries for chronic kidney disease [ 28 , 29 ].
We must emphasize that a specific offending agent cannot be identified in this case material, and it may be the combination of excess creatine and protein with steroid injections that compounds risk not incurred with the individual substances. Our working hypothesis is that under hydration rather than direct toxicity precipitated the kidney injury. Written informed consent was obtained from the patients for publication of these case reports and the accompanying images. He collected clinical information and wrote the first draft of the manuscript.
Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation. Conflict of interest statement. Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders Safa E.
Michael D Hughson; E-mail: View large Download slide. Development of focal segmental glomerulosclerosis after anabolic steroid abuse. Renal failure and exercise-induced rhabdomyolysis in patients taking performance-enhancing compounds. The effects of the recommended dose of creatine monohydrate on kidney function. Acute renal failure in a young weight lifter taking multiple food supplements.
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Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation. Evaluation of intestinal binding to improve the safety profile of oral sodium phosphate bowel cleansing. Epidemiology and outcomes in community-acquired versus hospital-acquired AKI.
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