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By Medifit Biologicals

ANABOLIC STEROIDS EFFECT ON KIDNEYS (NEPHRO ACTION)

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Medifit Biologicals describes how Anabolic androgenic steroids use disturbs the kidney functions. All users are medically advised to take proper medical supervision for nephrotoxicity prevention.

The researchers seem to believe that extreme increases in muscle mass require the kidneys to increase their filtration rate, placing harmful levels of stress on these organs. It may also be likely that anabolic steroids have direct toxic effects on the kidneys. “Athletes who use anabolic steroids and the doctors caring for them need to be aware of the potentially serious risks to the kidney,”

Athletes who use anabolic steroids may gain muscle mass and strength, but they can also destroy their kidney function, according to a paper being presented at the American Society of Nephrology’s 42nd Annual Meeting and Scientific Exposition in San Diego, CA. The findings indicate that the habitual use of steroids has serious harmful effects on the kidneys that were not previously recognized.

Reports of professional athletes who abuse anabolic steroids are increasingly common. Most people know that using steroids is not good for your health, but until now, their effects on the kidneys have not been known. Leal Herlitz, MD (Columbia University Medical Center) and her colleagues recently conducted the first study describing injury to the kidneys following long-term abuse of anabolic steroids. The investigators studied a group of 10 bodybuilders who used steroids for many years and developed protein leakage into the urine and severe reductions in kidney function. Kidney tests revealed that nine of the ten bodybuilders developed a condition called focal segmental glomerulosclerosis, a type of scarring within the kidneys. This disease typically occurs when the kidneys are overworked. The kidney damage in the bodybuilders has similarities to that seen in morbidly obese patients, but appears to be even more severe.

When the bodybuilders discontinued steroid use their kidney abnormalities improved, with the exception of one individual with advanced kidney disease who developed end-stage kidney failure and required dialysis. Also, one of the bodybuilders started taking steroids again and suffered a relapse of severe kidney dysfunction.

The researchers propose that extreme increases in muscle mass require the kidneys to increase their filtration rate, placing harmful levels of stress on these organs. It’s also likely that steroids have direct toxic effects on the kidneys. “Athletes who use anabolic steroids and the doctors caring for them need to be aware of the potentially serious risks to the kidney,” said Dr. Herlitz.

The kidney damage in the bodybuilders has similarities to that seen in morbidly obese patients, but appears to be even more severe.

 

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DETAIL DESCRIPTION & DISCUSSION

Over the past several decades we have seen an increase in the prevalence of anabolic steroid use by athletes. Because use of anabolic steroids is illicit, much of our knowledge of their side effects is derived from case reports, retrospective studies, or comparisons with studies in other similar patient groups. It has been shown that high-dose anabolic steroids have an effect on lowering high-density lipoprotein, increasing low-density lipoprotein, and increasing the atherogenic-promoting apolipoprotein A. Steroid abuse can also be hepatotoxic, promoting disturbances such as biliary stasis, peliosis hepatis, and even hepatomas, which are all usually reversible upon discontinuation. Suppression of the hypothalamic adrenal axis can also lead to profound adrenal changes that are also reversible with time. Although rare, renal side effects have also been documented, leading to acute renal failure and even Wilms’ tumors in isolated cases. Much of our knowledge of these potentially severe but usually limited side effects is confounded by use of combinations of different steroid preparations and by the concomitant use with other substances. Physicians must target their efforts at counseling adolescents and other athletes about the potential harms of androgenic anabolic steroids.

Athletes who use anabolic steroids may gain muscle mass and strength, but they can also destroy their kidney function, according to a new article. The findings indicate that the habitual use of steroids has serious harmful effects on the kidneys that were not previously recognized.

Reports of professional athletes who abuse anabolic steroids are increasingly common. Most people know that using steroids is not good for your health, but until now, their effects on the kidneys have not been known. Leal Herlitz, MD (ColumbiaUniversityMedicalCenter) and her colleagues recently conducted the first study describing injury to the kidneys following long-term abuse of anabolic steroids. The investigators studied a group of 10 bodybuilders who used steroids for many years and developed protein leakage into the urine and severe reductions in kidney function. Kidney tests revealed that nine of the ten bodybuilders developed a condition called focal segmental glomerulosclerosis, a type of scarring within the kidneys. This disease typically occurs when the kidneys are overworked. The kidney damage in the bodybuilders has similarities to that seen in morbidly obese patients, but appears to be even more severe.

When the bodybuilders discontinued steroid use their kidney abnormalities improved, with the exception of one individual with advanced kidney disease who developed end-stage kidney failure and required dialysis. Also, one of the bodybuilders started taking steroids again and suffered a relapse of severe kidney dysfunction.

Kareo and Falcon Herlitz help nephrology practices leverage cloud-based technology

The researchers propose that extreme increases in muscle mass require the kidneys to increase their filtration rate, placing harmful levels of stress on these organs. It’s also likely that steroids have direct toxic effects on the kidneys. “Athletes who use anabolic steroids and the doctors caring for them need to be aware of the potentially serious risks to the kidney,” said Dr. Herlitz.

 

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This study was conducted in the laboratory of Dr. Vivette D’Agati, MD at ColumbiaUniveristyMedicalCenter. Study co-authors include Glen Markowitz, MD, Joshua Schwimmer, MD, Michael Stokes, MD, Cheryl Kunis, MD, Vivette D’Agati, MD, (ColumbiaUniversityMedicalCenter); Alton Farris, MD, and Robert Colvin, MD (Massachusetts GeneralHospital).

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/m2).

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.

 

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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/m2.

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.

Many competitive bodybuilders take anabolic steroids to achieve their freakishly exaggerated physiques. That is no secret. But steroids can be only one part of an extreme regimen that can wreak havoc on the body.

Human growth hormone, supplements, painkillers and diuretics can also be used to create the “shrink-wrapped” muscles so prized in the aesthetic. And the high concentration of muscle mass puts stress on the body, as if the lifter were obese.

Lifting weights in the gym is “extremely healthy for you,” said Kenneth Wheeler, a former elite bodybuilder known as Flex. “But if you want to be a bodybuilder and compete at the highest level, it has nothing to do with health.” A relatively rare form of kidney disease forced Wheeler to retire in 2003 at age 37, and he needed a kidney transplant later that year.

 

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Determining the extent of the damage that bodybuilders inflict on themselves is difficult, in part because there is little interest in financing studies on such an extreme group, and because bodybuilders are not always honest about what they take. That is why a case study published last month by a top kidney journal is generating interest in the nephrology and bodybuilding communities. It is among the first to assert a direct link between long-term steroid use and kidney disease.

The study began 10 years ago when a kidney pathologist at ColumbiaUniversityMedicalCenter in New York noticed that a bodybuilder had an advanced form of kidney disease. Curious, she started looking for similar cases and eventually studied 10 men with serious kidney damage who acknowledged using steroids. Nine were bodybuilders and one was a competitive powerlifter with a similar training routine.

All 10 men in the case series, published in November by the Journal of the American Society of Nephrology, showed damage to the filters of the kidney. Nine had an irreversible disease known as focal segmental glomerulosclerosis — the same disease contracted by Wheeler — even though the men in the study did not have other apparent risk factors. Their disease was worse than in obese patients with a higher body-mass index, suggesting that steroids — combined with the other practices — might be harming the kidneys.

 

Among the study’s most persuasive details is the story of a man, 30 years old at the time, who damaged his kidneys after more than a decade of bodybuilding. The patient’s condition improved after he stopped using the drugs, discontinued his regimen and lost 80 pounds. But it worsened after the man, who became depressed, returned to bodybuilding and steroids.

 

“These patients are likely the tip of the iceberg,” said Vivette D. D’Agati, the lead researcher. “It’s a risk. A significant risk.”

 

Several experts not affiliated with the study said that while the claims were intriguing, the study’s value was limited because it focused only on intensive steroid users and because the bodybuilders’ layered training practices had to be taken into account. “I think it’s hard to be certain what’s causing their kidney disease,” said William Bremner, chairman of the Department of Medicine at the University of Washington and an endocrinologist who studies steroids.

D’Agati said, “It’s probably multiple factors that are converging in these patients, but the common entity in all of them is anabolic steroids.”

 

One participant in the study, Patrick Antonecchia, 46, competed in powerlifting and strong man events for more than 25 years and said he used steroids, supplements and a high-protein diet to attain feats such as pulling a 40,000-pound truck. He ended his career and stopped using steroids about a year ago, and in February received a diagnosis of serious kidney damage. His doctors warned him not to use the drugs again. “They said: ‘Pat. Don’t. Because it comes back,’ ” he said.

 

Antonecchia has lost about 50 pounds and said he misses the attention his 290-pound frame attracted: “The toughest thing now is it was my identity for 25 years. Now, when people see me, they say, ‘What happened to you?’ ”

 

Jerry Brainum writes a column for Iron Man Magazine called Bodybuilding Pharmacology and said he welcomes more research on the subject. “I found it very alarming, quite frankly,” Brainum said.

 

Since the 1990s, at least eight accomplished bodybuilders have died at a young age, and in addition to Wheeler, another six were forced to stop competing because of serious illness, often involving kidney disease.

The main source of information for bodybuilders is word of mouth and experimentation, Brainum said. “These guys have no guidance, they talk among themselves, and they don’t even tell the truth to each other,” he said.

 

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The risk-taking has been made worse by a trend toward ever larger physiques among the sport’s top competitors, some said. Jay Cutler, who won the 2009 Mr. Olympia contest, weighs almost 40 pounds more than Arnold Schwarzenegger did when he won the title in 1974, even though Cutler is five inches shorter.

“Each decade you have a guy that comes along that sets new standards and you say O.K., now I’m going to have to take it to the next level,” said Shahriar Kamali, a professional bodybuilder known as King.

 

Some bodybuilders expressed doubt that their practices were dangerous, pointing to former competitors who are still healthy in their 70s. They attributed the deaths of elite bodybuilders to the abuse of over-the-counter painkillers and diuretics, not steroids. The bodybuilding federation tests for diuretics at professional events, although competitors said they are still used.

Bodybuilders said that they were unfairly singled out as drug abusers when athletes in most other sports were also using performance-enhancing drugs. “Like anything else, it’s use and abuse,” Cicherillo said. “We’re the ones who are visual. We’re the ones who walk around, and you see us with the big muscles.”

Wheeler said he was convinced steroid use did not cause his kidney disease, although it might have made it worse.

 

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KIDNEY FAILURE

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.

The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine, and glomerular filtration rate (GFR).

Treatment of the underlying cause of kidney failure may return kidney function to normal. Lifelong efforts to control blood pressure and diabetes may be the best way to prevent chronic kidney disease and its progression to kidney failure. Usually, kidney function gradually decreases over time.

If the kidneys fail completely, the only treatment options available may be dialysis or transplant.

 

Woman undergoing kidney dialysis

 

 

 

 

 

 

 

 

 

 

 

 

  • DIALYSIS

You need dialysis when you develop end stage kidney failure –usually by the time you lose about 85 to 90 percent of your kidney function and have a GFR of <15.

Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.

There are two types of dialysis

HEMODIALYSIS AND PERITONEAL DIALYSIS.

 

HEMODIALYSIS

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

PERITONEAL DIALYSIS

Peritoneal dialysis involves the surgical implantation of a catheter into your stomach area. During treatment, a special fluid called dialystate is pumped into the abdomen where it draws waste out of the bloodstream.

 

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  • KIDNEY TRANSPLANTATION

A surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the donated kidney, which makes urine, just like your own kidneys did when they were healthy. The new kidney may start working right away or may take up to a few weeks to make urine. Unless your own kidneys are causing infection or high blood pressure, they are left in place.

You may receive a kidney from a deceased donor—a person who has recently died—or from a living donor. A living donor may be related or unrelated-usually a spouse or a friend. If you don’t have a living donor, you’re placed on a waiting list for a deceased donor kidney. The wait for a deceased donor kidney can be several years.

The transplant team considers three factors in matching kidneys with potential recipients. These factors help predict whether your body’s immune system will accept the new kidney or reject it.

Blood type. Your blood type (A, B, AB, or O) must be compatible with the donor’s. Blood type is the most important matching factor.

Human leukocyte antigens (HLAs). Your cells carry six important HLAs, three inherited from each parent. Family members are most likely to have a complete match. You may still receive a kidney if the HLAs aren’t a complete match as long as your blood type is compatible with the organ donor’s and other tests show no problems with matching.

Cross-matching antigens. The last test before implanting an organ is the cross-match. A small sample of your blood will be mixed with a sample of the organ donor’s blood in a tube to see if there’s a reaction. If no reaction occurs, the result is called a negative cross-match, and the transplant operation can

 

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By Medifit Biologicals

www.medifitbiologicals.com