Renal injury associated with anabolic steroid use

A case series.

Abstract

Introduction: The use of anabolic androgenic steroids (AASs) has been linked to a spectrum of kidney injuries ranging from acute kidney failure to end-stage chronic kidney disease. In these cases, not only the direct nephrotoxic effects of AAEs but also the impacts exacerbated by risky practices such as high-protein diets, multivitamin supplementation, and intentional dehydration are documented.

Clinical cases: Three patients consulted for emergencies at the Federico Lleras Acosta Hospital in Ibagué, Colombia. All patients received high doses of anabolic steroids associated with high-protein diets and creatine supplementation. All the participants were young men with good muscles, but none had a body mass index (BMI) ≥ 30 kg/m². The clinical events occurred in February, June, and August 2024. All patients had elevated creatinine levels, and the first clinical case presented with proteinuria in the nephrotic range. Microscopic urinalysis did not reveal glomerular hematuria, and the urine dipstick test was positive for protein and hemoglobin; immunoserology and viral serology were negative, and ultrasonography revealed chronicity.

Conclusions: AASs have direct toxic effects on the glomerulus and tubular system or can induce injury indirectly through adaptive mechanisms, hydroelectrolytes, and endocrine disorders. Evidence suggests that AAEs can cause direct kidney damage, including focal segmental glomerulosclerosis, acute interstitial nephritis, and rhabdomyolysis. In addition, high protein intake can increase the risk of kidney injury.