Sep 2, 2014 [h=1]http://www.medpagetoday.com/MeetingCoverage/ASN/16705 ASN: Anabolic Steroid Abuse May Damage Kidneys[/h]Published: Oct 30, 2009 By Todd Neale , Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner save |A A [h=2]Action Points[/h] Explain to interested patients that this study looked at renal damage as a previously unexplored consequence of abusing anabolic steroids. Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal. SAN DIEGO -- Among other hazards, bodybuilders who use anabolic steroids to improve their physique may be putting their kidneys at risk, researchers reported here. Ten bodybuilders who admitted to long-term use of steroids and other performance-enhancing drugs developed focal segmental glomerulosclerosis that was more severe than the condition found in a historical control group of morbidly obese individuals, Leal Herlitz, MD, of Columbia, reported at the American Society of Nephrology meeting here. They had higher mean serum creatinine (3.0 versus 1.47 mg/dL) and proteinuria (10.1 versus 4.09 g/day) and more glomerular and tubulointerstitial scarring. This was despite a lower BMI among the bodybuilders (34.6 versus 41.7 kg/m[SUP]2[/SUP]). It's unclear how prevalent such kidney damage is among individuals using anabolic steroids, "but I think it probably is under-recognized," Herlitz said. She speculated that the damage results from a combination of the glomeruli being overworked because of the increased lean body mass and also, "a direct toxic effect of these androgens and these anabolic steroids on the glomeruli." That combination likely explains the unusual severity of the disease in these bodybuilders, she said. A high-protein diet and exercise-induced hypertension were also likely contributors. Nephrologists and other clinicians should "be aware that even though somebody can look like they're the picture of health, it's not necessarily true," Herlitz said. She acknowledged that detecting kidney damage in heavily-muscled patients is difficult because they're expected to have an elevated serum creatinine level. That means it's also important to look for proteinuria and to get a history of steroid use, she said. Although anabolic steroids have several well-known adverse health effects, including testicular atrophy and gynecomastia, hepatotoxicity, and neuropsychiatric disturbances, renal injury had not been previously described, Herlitz said. She and her colleagues looked at 10 men (mean age 37) who participated in either bodybuilding (nine) or power-lifting (one). Their mean body mass index was 34.7 kg/m[SUP]2[/SUP]. All had protein leakage into the urine (mean 10.1 g/day) and a renal biopsy diagnosis of focal segmental glomerulosclerosis, glomerulomegaly, or both. Their mean serum creatinine was 3.0 mg/dL. Half of the men had full-blown nephrotic syndrome. Follow-up with a mean duration of 2.2 years was available for eight of the men. One progressed rapidly to end-stage renal disease despite discontinuation of steroid use. The other seven also discontinued anabolic steroids, reduced their level of exercise and received renin angiotensin system blockers. One also received corticosteroids. This led to weight loss and stabilization or improvement in serum creatinine (mean 2.34 to 1.61 mg/dL) and a drop in proteinuria (9.9 to 1.83 g/day). One of the men was unsatisfied with his body after discontinuing anabolic steroids and started taking them again. According to Herlitz, he said he'd rather go on dialysis than have a less bulky physique. His decision to start taking steroids again led to progressive proteinuria and renal insufficiency. In about three and a half years, his serum creatinine nearly doubled, from about 1.25 to nearly 2.5 mg/dL. His 24-hour urine protein increased from near 0 to 14 g/day. "He doesn't need to lose too much more [renal function] until he'll be considered to have severe chronic kidney disease," Herlitz said. He could reach end-stage renal disease in as little four to five years.