Abstract: FR-PO042

Can a Patient with Membranoproliferative Glomerulonephritis (MPGN) Following Anabolic Testosterone and Supplement Abuse Benefit from Glucocorticoid Treatment?

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Rowaiye, Olumide Olatubosun, Wroclaw Medical University, Wroclaw, Poland
  • Donizy, Piotr, Wroclaw Medical University, Wroclaw, Poland
  • Kusztal, Mariusz, Wroclaw Medical University, Wroclaw, Poland
  • Penar, Jozef, Wroclaw Medical University, Wroclaw, Poland
  • Halon, Agnieszka, Wroclaw Medical University, Wroclaw, Poland
  • Krajewska, Magdalena, Wroclaw Medical University, Wroclaw, Poland
  • Klinger, Marian, Wroclaw Medical University, Wroclaw, Poland
Background

The use of anabolic androgenic steroids (AAS) have been associated with a number of adverse effects; however, the occurrence of MPGN is uncommon. We describe a rare case of MPGN following anabolic testosterone and supplement abuse.

Methods

a 22-yr-old man with no significant past medical history presents with high serum creatinine (3.62 mg/dl), edema and gross hematuria. He admits that 8 months prior to presentation, he started a regimen of regular intensive physical workouts and OTC supplements (7 kg/month of a product containing 60.7 g of protein and 177.8 g of complex carbs). He used i.m. injections of testosterone enanthate (250 mg every 5 days for 3 months). Last testosterone dose was 3 months prior to presentation.
On examination, he was found to have BP 150/80 mmHg and lower extremity edema. Urinalysis revealed 2+ blood, active urinary sediments. Urine protein excretion was 4.6 g/day while serum albumin was 2.8 g/dl. Serological studies were negative for ANA, anti-dsDNA, ANCA, anti-GBM, HBV, HCV and HIV. CRP was normal. Serum C3 factor was low (0.17 g/l) while C4 was normal. Ultrasound showed enlarged kidneys: right -12.9 cm, left - 13.1 cm. Renal biopsy was performed which revealed active MPGN with segmental fibrinoid necrosis in 5 glomeruli but no crescents (fig 1). Also moderate tubulo-interstitial nephritis (TIN I/II°) (fig 2) was seen. Immunohistochemistry showed moderately intense mesangial IgG deposits in most glomeruli with a few mesangial IgM deposits; C3 was negative. Patient was treated with i.v. pulse methylprednisolone and i.v. diuretics which resulted in serum creatinine level of 1.77 mg/dl and disappearance of the edema. On follow-up visit 4 weeks later, serum creatinine was 1.38 mg/dl and patient continued to further improve.

Conclusion

Patients with MPGN following AAS and supplement abuse, with features of rapidly progressive glomerulonephritis may benefit from glucocorticoid treatment.