Coexistence of Interstitial Nephritis and the Cellular Variant of Focal Segmental Glomerulosclerosis Secondary to Anabolic Steroid Abuse.

Anabolic-androgenic steroids (AAS) have been widely used by young people to enhance performance and increase muscle mass. The use of AAS can affect the kidneys and lead to a myriad of presentations, ranging from mildly elevated serum creatinine and blood urea nitrogen to irreversible chronic kidney disease and focal segmental glomerulosclerosis (FSGS). To the best of our knowledge, the coexistence of interstitial nephritis and the cellular variant of FSGS [Immunoglobulin M (IgM)] secondary to AAS abuse has not been previously reported in the literature. Here, we report the case of a 40-year-old bodybuilder who developed simultaneous interstitial nephritis and the cellular variant of FSGS (IgM) after short-term use of AAS and other dietary supplements.

Acne related to dietary supplements.

Multiple prescription medications may cause or aggravate acne. A number of dietary supplements have also been linked to acne, including those containing vitamins B6/B12, iodine, and whey, as well as "muscle building supplements" that may be contaminated with anabolic-androgenic steroids (AAS). Acne linked to dietary supplements generally resolves following supplement discontinuation. Lesions associated with high-dose vitamin B6 and B12 supplements have been described as monomorphic and although pathogenesis is unknown, a number of hypotheses have been proposed. Iodine-related acne may be related to the use of kelp supplements and has been reported as monomorphic, inflammatory pustules on the face and upper trunk. Whey protein supplements, derived from milk and used for bodybuilding, are associated with papulonodular acne involving the trunk and sometimes the face. Finally, AAS-induced acne has been described as acne fulminans, acne conglobata, and acne papulopustulosa. With studies indicating that about half of US adults report using dietary supplements, it is important that dermatologists directly ask acne patients about their supplement use and educate them on the potential risks of even seemingly innocuous dietary supplements.

Consumption of avocado oil (Persea americana) improves the biochemical profile of rats submitted to long-term androgenic stimulation.

INTRODUCTION: Introduction: indiscriminate use of anabolic steroids is associated with cardiovascular diseases, renal damage, and hepatic toxicity. Contrastingly, nutraceutical foods such as avocados prevent and control several diseases, as they can reduce the effects of oxidative stress. Objective: this study evaluates the benefits of consuming an avocado oil-based diet to attenuate the systemic damage caused by supraphysiological doses of testosterone, by analyzing the biochemical profile of 28 42-day-old male Wistar rats. Methods: silicone pellets containing testosterone were surgically implanted, and they received control or avocado oil-based feed. After 20 weeks, all the male rats were anesthetized and their blood samples collected. Results: although the high hormone concentration had a negative influence on the biochemical profile of these animals, the groups that consumed avocado oil exhibited a reduction in serum triacylglycerols (-21 %; p = 0.0001), VLDL (-20 %; p = 0.0085), LDL (-78 %; p < 0.0001), and total cholesterol (-12 %; p < 0.0001), along with positive changes in their HDL concentrations (+7 %; p = 0.001). The avocado oil groups also manifested a reduction in the total concentration of serum proteins (-24 %; p = 0.0357), albumin (-26 %; p = 0.0015), urea (-14 %; p = 0.04), and creatinine (-33 %; p < 0.0001). The concentration of liver transaminases was found to be higher in the animals included in the induced group (ALT, +66 %; p = 0.0005, and AST, +23 %; p = 0.0021), whereas they remained stable in the avocado oil group. Conclusion: from the above, it may be concluded that supraphysiological doses of testosterone are related to increased risk factors for cardiovascular, renal, and hepatic diseases, and that the consumption of avocado oil shields the biochemical profile, thus reducing the associated risk factors.

INTRODUCCIÓN: Introducción: el uso indiscriminado de esteroides anabólicos se asocia con enfermedades cardiovasculares, daño renal y toxicidad hepática. En cambio, los alimentos nutracéuticos como el aguacate previenen y controlan varias enfermedades, ya que pueden reducir los efectos del estrés oxidativo. Objetivo: este estudio evalúa los beneficios de consumir una dieta basada en aceite de aguacate para atenuar el daño sistémico causado por dosis suprafisiológicas de testosterona mediante el análisis del perfil bioquímico de 28 ratas Wistar macho de 42 días de edad. Métodos: se implantaron quirúrgicamente perdigones de silicona que contenían propionato de testosterona y los animales recibieron una alimentación de control o una basada en el aceite de aguacate. Después de 20 semanas se anestesiaron todos los animales y se recogieron sus muestras de sangre. Resultados: aunque la alta concentración de hormonas tuvo una influencia negativa en el perfil bioquímico de estos animales, los grupos que consumieron aceite de aguacate mostraron una reducción de los triglicéridos séricos (-21 %; p = 0,0001), las VLDL (-20 %; p = 0,0085), las LDL (-78 %; p < 0,0001) y el colesterol total (-12 %; p < 0,0001), con cambios positivos en las LDL (+7 %; p = 0,001). Los grupos alimentados con aceite de aguacate manifestaron una reducción de la concentración total de proteínas séricas (-24 %; p = 0,0357), albúmina (-26 %; p = 0,0015), urea (-14 %; p = 0,04) y creatinina (-33 %; p < 0,0001). Se encontró que la concentración sérica de transaminasas hepáticas era mayor en los animales del grupo inducido (ALT: +66 %; p = 0,0005, y AST: +23 %; p = 0,0021), mientras que en los grupos con aceite de aguacate, los parámetros hepáticos se mantuvieron estables. Conclusión: de todo ello se puede concluir que las dosis suprafisiológicas de testosterona están relacionadas con un aumento de los factores de riesgo de sufrir enfermedades cardiovasculares, renales y hepáticas, y que el consumo de aceite de aguacate protege el perfil bioquímico, lo que reduce los factores de riesgo asociados.

Kidney disease associated with androgenic-anabolic steroids and vitamin supplements abuse: Be aware!

The excessive chase for beauty standards and the rise of muscle dysmorphia have ultimately led to an increase in androgenic-anabolic steroids (AAS) and intramuscular injections of vitamins A, D and E (ADE) abuse, which is associated with several adverse effects and has become a public health issue. This review of literature discusses kidney injury associated with the use of AAS and ADE, highlighting the mechanisms of acute and chronic renal lesion, such as direct renal toxicity, glomerular hyperfiltration and hypercalcemia. Future perspectives regarding evaluation and early diagnosis of kidney injury in these patients are also discussed.

The potential effects of anabolic-androgenic steroids and growth hormone as commonly used sport supplements on the kidney: a systematic review.

BACKGROUND: Anabolic-androgenic steroids and growth hormone are among the most commonly used supplements by sportsmen and sportswomen. The aim of this systematic review is to collect and report available data about renal safety of anabolic-androgenic steroids and growth hormone (GH). METHODS: The search strategy was in accordance with the PRISMA guideline. Seven databases such as Scopus, Medline, Embase, and ISI Web of Knowledge were searched using keywords, such as "growth hormone", "anabolic-androgenic steroids", and "kidney injury". Articles published from 1950 to December 2017 were considered. Randomized clinical trials, prospective or retrospective human studies, case series as well as case reports, and experimental (in vivo) studies were included. Twenty one clinical and experimental articles were selected (12 for anabolic-androgenic steroids and 9 for GH). RESULTS: Anabolic-androgenic steroids can affect the kidney in different aspects. They can induce or aggravate acute kidney injury, chronic kidney disease, and glomerular toxicity. These adverse effects are mediated through pathways such as stimulating renin-angiotensin-aldosterone system, enhancing the production of endothelin, producing reactive oxygen species, over-expression of pro-fibrotic and pro-apoptotic mediators (e.g., TGF-ß1), as well as inflammatory cytokines (e.g., TNF-α, IL-1b, and IL-6). Although GH may affect the kidney in different aspects, such as size, glomerular filtration rate, and tubule functions, either directly or indirectly, there is no conclusive clinical evidence about its detrimental effects on the kidney in athletes and body builders. CONCLUSION: Evidence regarding effects of anabolic-androgenic steroids exists; However, GH's exact effect on the kidney at doses used by athletes and body builders has not yet been clarified. Cohort clinical studies with long-term follow-up are warranted in this regard.

Anabolic-androgen steroids effects on bioenergetics responsiveness of synaptic and extrasynaptic mitochondria.

We hypothesized that supraphysiological administration of the anabolic-androgenic steroids (AAS) like testosterone (TEST) and nandrolone decanoate (NAND) might differentially affect synaptic and extrasynaptic components of mitochondrial bioenergetics, thereby resulting in memory impairment. Oil (VEH), NAND or TEST (15 mg/Kg) were daily administered to male CF-1 albino mice for 19-days. We evaluated in the synaptosomes and extrasynaptic mitochondria, Ca2+ influx/efflux, membrane potential ΔÑ°m, oxidative respiratory states, dehydrogenases activity, H2O2 production, Tau phosphorylation, and spatial memory in the Morris water maze (MWM). In synaptosomes, both AAS increased Ca2+ influx and Na+ dependent efflux. In extrasynaptic mitochondria, NAND increased the Ca2+ influx. NAND prominently impaired ΔÑ°m formation and dissipation in synaptosomal and extrasynaptic mitochondria, while the effect of TEST was less pronounced. TEST increased the Reserve Respiratory Capacity in synaptosomes, and NAND decreased dehydrogenases activity in synaptic and extrasynaptic mitochondria. Also, NAND increased H2O2 production by synaptosomes and extrasynaptic mitochondria. NAND increased pTauSer396 in synaptosomes. Both AAS did not impair memory performance on MWM. We highlight that high doses of NAND cause neurotoxic effects to components of synaptic and extrasynaptic mitochondrial bioenergetics, like calcium influx, membrane potential and H2O2 production. TEST was less neurotoxic to synaptic and extrasynaptic mitochondrial bioenergetics responses.

Determinação de estimulantes, esteroides anabolizantes, diuréticos e laxante por HPLC-DAD e LC-MS/MS em suplementos alimentares adulterados disponíveis no Brasil / Determination of stimulants, anabolic steroids, diuretics and laxative by HPLC-DAD and LC-MS/MS in adulterated dietary supplements available in Brazil

A adulteração de suplementos alimentares pela adição de substâncias farmacologicamente ativas e um problema que vem se agravando nos últimos anos. Essas substâncias são adicionadas intencionalmente nos produtos, com objetivo de melhorar a sua eficácia, sem que essa adição seja devidamente informada nos rótulos. O consumo de suplementos adicionados de substâncias farmacologicamente ativas nao declaras nos rótulos e, alem de um problema de saúde pública, um risco a carreira de atletas profissionais, quando se trata de doping no esporte. Neste trabalho foram desenvolvidos métodos analíticos baseados em cromatografia líquida para detecção de 19 substâncias farmacologicamente ativas em amostras de suplementos alimentares, nos niveis de contaminação cruzada e adulteração. Para tal, empregou-se a cromatografia líquida de alta eficiência acoplada a detector de arranjo de diodos (HPLC-DAD) e a cromatografia líquida acoplada a espectrometria de massas sequencial (LC-MS/MS). As substâncias investigadas apresentam ação androgênica e anabólica (i.e. testosterona, metiltestostetona, propionato de testosterona, decanoato de testosterona, trembolona, estanozolol, dehidroepiandrosterona, androstenediona, decanoato de nandrolona, oxandrolona e metasterona), estimulante (i.e. cafeína), anorexigena (i.e. sibutramina), diurética (i.e. amilorida, bumetanida, furosemida, hidroclorotiazida e clortalidona) e laxante (i.e. fenolftaleina). Entre os métodos de preparo de amostra avaliados (Quechers e extração sólido-líquido seguida de uma etapa de precipitação de proteína), a extração sólido-líquido empregando metanol como solvente extrator e ZnSO4 como agente precipitante apresentou-recuperação acima de 80% para todas as substâncias avaliadas, sendo selecionado para o fim deste estudo. Os métodos analíticos propostos apresentaram limites de detecção e de quantificação na faixa de contaminação, foram seletivos e lineares com r2 superior a 0,99 na faixa de concentração de interesse para todas as substâncias e valores de recuperação, precisão e exatidão dentro dos valores aceitáveis. Um conjunto amostral representativo dos suplementos alimentares comercializados no Brasil, constituído por 230 amostras, foi analisado sendo que mais de 25% do conjunto amostra foram positivos para cafeína (48), sibutramina (14), fenolftaleína (2) e furosemida (3), isoladas ou associadas entre si. Os métodos desenvolvidos utilizaram um preparo de amostra simples e apresentaram resultados satisfatórios para a investigação de possível adulteração ou contaminação com 19 das substâncias de interesse. Dos 58 suplementos alimentares adulterados, apenas 11 podem ser considerados adulterados por contaminação cruzada. Os demais, são consideradas adições dolosas por parte dos fabricantes com objetivo de melhorar a eficiência dos seus produtos. Os resultados aqui apresentados indicam a necessidade de ações mais efetivas por parte das autoridades sanitárias no sentido de fiscalizar com mais eficiência a produção e a comercialização desses produtos e alertar a população para que fiquem atentos a possível adulteração de suplementos alimentares e aos riscos associados ao consumo desses produtos

The adulteration of dietary supplements by the addition of pharmacologically active substances is a serious issue, which is aggravating steadily. These substances are added intentionally in various products, with the aim of improving their effectiveness, but without proper labeling stating so. In addition to a public health problem, the consumption ofsupplements added with undeclared pharmacologically active substances also represents a career risk for professional athletes when it comes to doping in sport. In the present work, analytical methods based on liquid chromatography were developed for the detection of 19 pharmacologically active substances in dietary supplement samples at the levels of crosscontamination and adulteration. For this purpose, high performance liquid chromatography/diode array detector (HPLC-DAD) and liquid chromatography/tandem mass spectrometry (LC-MS/MS) were used. The investigated substances comprise of androgenic and anabolic effects (ie testosterone, testosterone propionate, testosterone decanoate, trenbolone, stanozolol, dehydroepiandrosterone, androstenedione, nandrolone decanoate, oxandrolone and metasterone), stimulant (ie caffeine), anorexigenic (ie sibutramine), diuretic (ie amiloride, bumetanide, furosemide, hydrochlorothiazide and chlorthalidone) and laxative (ie phenolphthalein). Among the sample preparation methods evaluated (Quechers and solidliquid extraction followed by a protein precipitation step), solid-liquid extraction using methanol as extraction solvent and ZnSO4 as the precipitating agent has been chosen as it has shown recovery values above 80% for all evaluated substances. The proposed analytical methods had limits of detection and quantification within the contamination range, they were also selective and linear showing r2 values higher than 0.99 in the concentration range of interest for all substances and accuracy within acceptable values. A representative sampling of dietary supplements marketed in Brazil, consisting of 230 samples, was analyzed and more than 25% have shown to be positive for caffeine (48), sibutramine (14), phenolphthalein (2) and furosemide (3), isolated or associated with each other. The methods developed used a simple sample preparation and presented satisfactory results for the investigation of possible adulteration or cross-contamination for the 19 of the substances of interest. From a total of 58 adulterated dietary supplements, only 11 could be considered adulterated by crosscontamination. The remaining are considered to be intentional additions by manufacturers in order to improve the efficiency of their products. The results presented in this study indicate the need for more effective measures by the health authorities towards the production and marketing of these products so that the general public is aware of their potential adulteration and the risks associated with their consumption

[FSGS collapsing variant during anabolic steroid abuse: Case Report].

Anabolic Androgenic Steroids (AAS) is an hormone family whose use has considerably increased among body-builders during the last decades. The AAS abuse, especially associated with other drugs or nutritional supplements and protein loads, may cause a variety of pathologies to several organs with a mechanism related to dosage, timing and substance. The kidney is the main metabolizer of these drugs and it can be acutely or chronically damaged with ESKD. The literature reports some cases of Focal Segmental Glomerulosclerosis (FSGS) in body-builders who abused of AAS. However, the link is not well understood and limited to some case-studies. In this paper, we report the case of a young body-builder who developed a FSGS collapsing variant with ESKD after prolonged abuse of AAS and a strongly hyperproteic diet and other dietary supplements. The patient underwent a genetic test because of the rapid and irreversibile onset of ESKD. The test showed a gene mutation of ACTN4, predisposing and causal of some genetic forms of FSGS. It was a very complex case, caused by several factors. The mutant protein of ACTN4 gene makes most vulnerable the cytoskeleton of the podocytes to external disturbances. That would explain why in those patients where the mutation has occurred, only those patients subject to "unfavorable environmental conditions", like the abuse of AAS, can develop a disease.

Liver Injury Associated with Sporting Activities.

Exertional heat stroke most commonly develops following prolonged levels of aerobic activity in a warm or humid environment. Hypoperfusion of the vital organs along with activation of the inflammasome can lead to progressive and potentially fatal multiorgan failure including acute liver failure. In the United States, herbal and dietary supplements that are marketed to improve performance, strength, and weight loss are increasingly being used by both amateur and professional athletes. Consumption of bodybuilding supplements that contain androgenic anabolic steroids can lead to adverse hepatic effects ranging from asymptomatic serum aminotransferase elevations to severe cholestatic hepatitis with prolonged jaundice. Various non-bodybuilding nutritional supplements that contain a mixture of botanicals, caffeine, and chemicals have also been associated with idiosyncratic hepatotoxicity. In particular, green tea extract derivatives that contain epigallocatechin gallate are hepatotoxic in animal models and have been associated with severe acute hepatocellular injury in humans.

Anabolic Steroid Effect on the Liver.

Anabolic steroids are synthetic derivatives of testosterone shown to increase muscle size and strength. Chemical substitutions on the testosterone molecule cause increased potency and duration of action. The 17-α-alkylation modification allows steroids to be taken orally, but the slower clearance in the liver makes them more hepatotoxic. The frequency and severity of side effects depends on several factors including the formulation of the drug, route of administration, dosage, duration of use, and individual sensitivity and response. Anabolic steroid users tend to take supraphysiologic doses or multiple steroids and other drugs simultaneously which increases risk of adverse effects. Hepatotoxicity can be seen as elevated liver transaminases, acute cholestatic syndrome, chronic vascular injury, hepatic tumors, and toxicant-associated fatty liver disease, as well as significant changes in lipoproteins. Many of these changes will stabilize or reverse with cessation of steroid use, but some can be life-threatening. Over-the-counter supplements can be contaminated with anabolic steroids, causing hepatotoxicity in unsuspecting consumers.

Anabolic steroids for treating pressure ulcers.

BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers. Anabolic steroids are considered because of their ability to stimulate protein synthesis and build muscle mass. Comprehensive evidence is required to facilitate decision making, regarding the benefits and harms of using anabolic steroids. OBJECTIVES: To assess the effects of anabolic steroids for treating pressure ulcers. SEARCH METHODS: In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: Published or unpublished randomised controlled trials (RCTs) comparing the effects of anabolic steroids with alternative treatments or different types of anabolic steroids in the treatment of pressure ulcers. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out study selection, data extraction and risk of bias assessment. MAIN RESULTS: The review contains only one trial with a total of 212 participants, all with spinal cord injury and open pressure ulcers classed as stage III and IV. The participants were mainly male (98.2%, 106/108) with a mean age of 58.4 (standard deviation 10.4) years in the oxandrolone group and were all male (100%, 104/104) with a mean age of 57.3 (standard deviation 11.6) years in the placebo group. This trial compared oxandrolone (20 mg/day, administered orally) with a dose of placebo (an inactive substance consisting of 98% starch and 2% magnesium stearate) and reported data on complete healing of ulcers and adverse events. There was very low-certainty evidence on the relative effect of oxandrolone on complete ulcer healing at the end of a 24-week treatment period (risk ratio RR) 0.81, 95% confidence interval (CI) 0.52 to 1.26) (downgraded twice for imprecision due to an extremely wide 95% CI, which spanned both benefit and harm, and once for indirectness, as the participants were mostly male spinal cord injury patients). Thus, we are uncertain whether oxandrolone improves or reduces the complete healing of pressure ulcers, as we assessed the certainty of the evidence as very low.There was low-certainty evidence on the risk of non-serious adverse events reported in participants treated with oxandrolone compared with placebo (RR 3.85, 95% CI 1.12 to 13.26) (downgraded once for imprecision and once for indirectness, as the participants were mostly male spinal cord injury patients). Thus, the treatment with oxandrolone may increase the risk of non-serious adverse events reported in participants.There was very low-certainty evidence on the risk of serious adverse events reported in participants treated with oxandrolone compared with placebo (RR 0.54, 95% CI 0.25 to 1.17) (downgraded twice for imprecision due to an extremely wide 95% CI, which spanned both benefit and harm, and once for indirectness, as the participants were mostly male spinal cord injury patients). Of the five serious adverse events reported in the oxandrolone-treated group, none were classed by the trial teams as being related to treatment. We are uncertain whether oxandrolone increases or decreases the risk of serious adverse events as we assessed the certainty of the evidence as very low.Secondary outcomes such as pain, length of hospital stay, change in wound size or wound surface area, incidence of different type of infection, cost of treatment and quality of life were not reported in the included trial.Overall the evidence in this study was of very low quality (downgraded for imprecision and indirectness). This trial stopped early when the futility analysis (interim analysis) in the opinion of the study authors showed that oxandrolone had no benefit over placebo for improving ulcer healing. AUTHORS' CONCLUSIONS: There is no high quality evidence to support the use of anabolic steroids in treating pressure ulcers.Further well-designed, multicenter trials, at low risk of bias, are necessary to assess the effect of anabolic steroids on treating pressure ulcers, but careful consideration of the current trial and its early termination are required when planning future research.

Muscle mania: the quest for the perfect body.

We describe the case of a young man with repeated hospital presentations for a variety of symptoms related to excessive bodybuilding and associated behaviours. He presented to our department (radiology) with right arm pain and loss of function. Ultrasound showed complete triceps rupture, rare in young patients and multiple cystic areas within the muscles of the arm. MRI revealed these to be multiple proteinaceous lesions within the muscle bellies and the possibility of self-innoculation was raised by the reporting radiologist. The patient subsequently admitted to injecting coconut oil to improve muscle contour lost secondary to injury. A review of his hospital presentations was then made and revealed further concerning practices performed by the patient to enhance his muscular appearance.

Guerilla Warfare on the Pancreas? A Case of Acute Pancreatitis From a Supplement Known to Contain Anabolic-Androgenic Steroids.

INTRODUCTION: Performance-enhancing drugs (PEDs) are commonly consumed in the United States with high prevalence of use in athlete populations and increased use by deployed service members. Many PEDs may contain anabolic-androgenic steroids (AAS), which are legally restricted and prohibited by many agencies due to their health risk. CASE DESCRIPTION: A unique case of acute pancreatitis associated with the use of the PED "Guerilla Warfare," a labeled AAS-containing supplement, is presented. The patient is a healthy 20-year-old male Marine who presented with multiple episodes of abdominal cramps each day for a month with decreased appetite and nonbilious vomiting. He reported a 6-week history of "Guerilla Warfare" PED use and review of systems identified fatigue and 12 lb reported weight loss. He presented with normal vital signs, tenderness in upper abdominal quadrants, elevated lipase (909 units/L), lactate dehydrogenase (193 units/L), and an enlarged pancreas with surrounding inflammation on computed tomography. SUMMARY: This constitutes the first report of acute pancreatitis with the use of "Guerilla Warfare," and the second reported case with the use of any AAS-containing PED. Increased awareness of significant PED-associated adverse effects by both the civilian and military communities is needed to better characterize these risks moving forward.

Synthetic androgens as designer supplements.

Anabolic androgenic steroids (AAS) are some of the most common performance enhancing drugs (PED) among society. Despite the broad spectrum of adverse effects and legal consequences, AAS are illicitly marketed and distributed in many countries. To circumvent existing laws, the chemical structure of AAS is modified and these designer steroids are sold as nutritional supplements mainly over the Internet. Several side effects are linked with AAS abuse. Only little is known about the pharmacological effects and metabolism of unapproved steroids due to the absence of clinical studies. The large number of designer steroid findings in dietary supplements and the detection of new compounds combined with legal loopholes for their distribution in many countries show that stricter regulations and better information policy are needed.

[Nephrocalcinosis associated with the use of anabolic steroid]. / Nefrocalcinose associada ao uso de esteroide anabolizante.

UNLABELLED: The anabolic steroid have been used as a therapeutic tool in various clinical conditions. However, indiscriminate use associated with other nutritional supplements has generated serious adverse effects. CASE REPORT: Male, 21 years old, admitted with nausea, fatigue, appetite loss, headache and hypertension. Blood tests showed Cr: 3.9 mg% U: 100 mg% and Total Calcium 14 mg/dl. Ultrasonography and renal biopsy were consistent with nephrocalcinosis. There has been gradual improvement in renal function and calcium levels after vigorous hydration and furosemide. However, after 1 year, renal calcium deposits persist, corticomedullary ratio reduced in ultrasound and stable creatinine of 1.4 mg/dl. Previous cases showed acute tubular necrosis and interstitial nephritis with little calcium deposits in the renal interstitium. In this case we found severe nephrocalcinosis associated with nephrosclerosis. Our objective is to report the occurrence of acute kidney Injury with nephrocalcinosis associated with use of anabolic steroid and provide a review of the matter.

Nefrocalcinose associada ao uso de esteroide anabolizante / Nephrocalcinosis associated with the use of anabolic steroid

Os esteroides anabolizantes têm sido usados como arma terapêutica em diversas condições clínicas. Entretanto, o uso abusivo e indiscriminado, associado a outros suplementos nutricionais, tem gerado efeitos adversos graves. Relato do caso: Sexo masculino, 21 anos, admitido com náuseas, astenia, hiporexia, cefaleia e hipertensão arterial. Exames no sangue evidenciaram Cr: 3,9 mg/dl U:100 mg/dl e Cálcio total 14 mg/dl. Ultrassonografia e biópsia renal compatíveis com nefrocalcinose. Houve melhora gradativa da função renal e da calcemia após hidratação vigorosa e furosemida. Entretanto, após 1 ano, persistiram depósitos renais de cálcio e relação córticomedular reduzida ao ultrassom e creatinina estável em 1,4 mg/dl. Casos anteriores evidenciaram necrose tubular aguda e nefrite intersticial com poucos depósitos de cálcio no interstício renal. Nesse caso, encontramos nefrocalcinose acentuada associada à nefroesclerose. O objetivo deste estudo é relatar a ocorrência de injúria renal aguda com nefrocalcinose associada ao uso de esteroide anabolizante e oferecer uma revisão do assunto. .

The anabolic steroid have been used as a therapeutic tool in various clinical conditions. However, indiscriminate use associated with other nutritional supplements has generated serious adverse effects. Case report: Male, 21 years old, admitted with nausea, fatigue, appetite loss, headache and hypertension. Blood tests showed Cr: 3.9 mg% U: 100 mg% and Total Calcium 14 mg/dl. Ultrasonography and renal biopsy were consistent with nephrocalcinosis. There has been gradual improvement in renal function and calcium levels after vigorous hydration and furosemide. However, after 1 year, renal calcium deposits persist, corticomedullary ratio reduced in ultrasound and stable creatinine of 1.4 mg/dl. Previous cases showed acute tubular necrosis and interstitial nephritis with little calcium deposits in the renal interstitium. In this case we found severe nephrocalcinosis associated with nephrosclerosis. Our objective is to report the occurrence of acute kidney Injury with nephrocalcinosis associated with use of anabolic steroid and provide a review of the matter. .