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Kidney Week

Abstract: PO0190

Roid Renal Failure

Session Information

  • AKI Mechanisms - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Mallari, Margaret, AtlantiCare Regional Medical Center, Atlantic City, New Jersey, United States
  • Thakkar, Priyesh T., AtlantiCare Regional Medical Center, Atlantic City, New Jersey, United States
Introduction

Athletes and bodybuilders often utilize anabolic steroids and high-protein supplements to gain muscle mass, however the use of such performance enhancers comes with a significant risk of renal failure.

Case Description

A 34-year-old male weightlifter presented with worsening exertional dyspnea, hemoptysis, and bilateral leg swelling over 2-3 months. He admitted to weekly testosterone injections, testosterone-increasing supplements, and a high-protein diet for the past 5 years. To address his lower leg swelling, the patient started Expel, an over-the-counter potassium-sparing diuretic, 2 months ago. Labs were significant for bicarb 19 mmol/L (21-30), BUN 166 mg/dL (8-25), Cr 13.4 mg/dL (.3-1.2), and CPK 2630 U/L (26-308). Chest X-ray showed right lower lobe pneumonia. Urinalysis showed proteinuria. Renal ultrasound revealed cortical echogenicity with no hydronephrosis. The patient was admitted for acute renal failure, rhabdomyolysis, and pneumonia. He was started on Ceftriaxone and Azithromycin and placed on IV fluids. During the hospitalization, the patient’s renal function deteriorated. Renal biopsy showed global and segmental glomerulosclerosis, tubular atrophy, severe interstitial fibrosis, arteriosclerosis, and arteriolar hyalinosis. The patient was counseled at length about long term renal replacement therapy and the gravity of his diagnosis. He underwent placement of a tunneled dialysis catheter and was discharged with close outpatient follow up. Unfortunately despite multiple hospitalizations, the patient repeatedly missed dialysis treatments and continued to use anabolic steroids and high-protein supplements.

Discussion

The utilization of anabolic steroids and high-protein supplements is widespread among athletes and bodybuilders seeking to enhance performance and achieve greater muscle mass. However, steroids and high-protein supplements are not benign and their use comes at the risk of renal failure requiring possible long term renal replacement therapy. High-protein supplements increase glomerular filtration rates (GFR) and are associated with the development of focal segmental glomerulosclerosis (FSGS). Anabolic steroids are directly toxic to renal glomeruli. Anabolic steroids bind to podocyte androgen receptors resulting in the apoptotic destruction of podocytes. The patient’s clinical course highlights the significant risk of renal failure in young athletes abusing anabolic steroids and high-protein supplements.