Effects of AAS on Kidneys

[200gamblr]

Any one got some comments (or links) on the effects of AAS on the Kidneys?
I finished a cycle (and PCT) in Oct 2010 did bloods in Dec 2010, came back clean good test levels etc. Did bloods again Feb 2011 and my Kidney reading is low (which puts it into the Chronic Kidney Failure category). Looking for some info on what this actually means. The reading was 57 mL/min/1.73m 2. (In Australia think they measure differently in the US)

[terraj]

Sorry man, I'm not going to comment on your numbers, thats the doc job.

Something that gets looked over time and time again, we think the liver is the only organ stressed, when kindey damage is something that be a greater risk for many. Kindeys are often called a silent organ, this means you won't know they are in trouble until it is to late, they also don't repair themselves as other organs such as the liver can.
We have seen more then a few Pros and PLs and strongman have there arses handed to them by steroid related kidney damage....steroids and very high protein diet.....that is something we need to be mindful of.


"The kidneys can undergo more possible strain during anabolic steroid intake. Kidneys are involved in some of the filtration and excretion systems of the body, and as such, when a foreign substance is administered, they necessarily work harder. Some steroid users have noticed very dark urine when on a cycle, and this is indicative of the kidneys working overtime to accomplish their goal. One of the major offenders of this seems to be Trenbolone, which turns the user s urine a very dark color unless enough water is taken in daily. Also, even though I know you re probably getting sick of hearing this from me, the possibility of side effects is dependant on both dose as well as compounds administered. Some steroids (Nandrolone) are even used to help treat people with Kidney problems! So clearly, they aren´t as bad as they´re made out to be with regards to possible kidney issues."

"November 4, 2009 (San Diego, California) — Coaches and clinicians should consider adding kidney disease to the long list of health problems associated with anabolic steroid abuse, according to new findings presented here at Renal Week 2009: American Society of Nephrology 2009 Annual Meeting.

"We think there is a direct toxic effect between steroid abuse and kidney damage," said Vivette D. D'Agati, MD, professor of pathology and director of the Renal Pathology Laboratory at Columbia University Medical Center in New York City, and senior author of the study.

She and her colleagues first noticed the connection in 1999, while studying the relation between kidney disease and obesity. One of the patients was a bodybuilder, whose body mass index (BMI) of 41 kg/m2 more than met the technical definition of obesity (≥30 kg/m2), but whose excess weight came from lean body mass rather than fat. The patient told the investigators he engaged in power lifting for several hours a day and used anabolic androgenic steroids (AAS).

Between 1999 and 2009, the authors identified a total of 10 men with an average age of 37 years and an average BMI of 34.7 kg/m2, the result of highly muscular physiques from bodybuilding. All admitted to long-term AAS abuse and had proteinuria levels of 1 g/day or more and biopsy-confirmed focal segmental glomerulosclerosis or glomerulomegaly. Five of the 10 patients had full nephrotic syndrome.

Of 8 patients available for long-term follow-up (average follow-up, 2.2 years), 7 reduced their exercise and discontinued AAS use, which resulted in weight loss, stabilization or improvement in serum creatinine levels, and reduced proteinuria. One patient experienced progressive proteinuria and renal insufficiency when he resumed taking AAS.

Renal impairment was worse among the bodybuilders than among a historic control group of 65 obese patients, even though the obese patients had a higher mean BMI (41.7 kg/m2). Mean baseline serum creatinine level among the bodybuilders was 3.0 mg/dL, compared with 1.47 mg/dL in the obese group. The bodybuilders had a mean proteinuria level of 10.1 g/day, compared with 4.09 g/day among the obese group. Thirty percent of the bodybuilders were fully nephrotic, compared with 5.6% of the obese patients.

The authors did not analyze statistical significance between the groups because they used historic controls, Dr. D'Agati explained. Still, "this made us hypothesize that this was a direct toxic effect of AAS, and not just renal overwork from the excess weight."

Glomerular cells have androgen receptors, which could make them prime targets for exogenous steroids, she noted. Most of the bodybuilders had been taking the AAS for as long as 10 years, and many of them also were using other hormones, such as insulin and growth hormone, and consuming diets extremely high in protein. Six of the men had hypertension. "Power lifting can send your systolic blood pressure up to 400 mm Hg," Dr. D'Agati pointed out. "Imagine doing that for 6 hours a day."

One encouraging finding was that proteinuria and serum creatinine levels stabilized or became less severe in 7 of the 10 subjects when they discontinued the AAS, prolonged exercise, and other components of the bodybuilding regimen.

Perhaps the biggest challenge in conducting the study was getting the bodybuilders to talk about their steroid abuse. "We have many other patients on file, but we couldn't include them in the study because they would not admit to using steroids," Dr. D'Agati explained.

"I think this is a great study. It is the first published study to document this effect," said Nina Reiniger, PhD, a postdoctoral scientist in nephrology at Columbia University, who was not involved in this research. "The small sample size didn't bother me because it is a correlational study. Even 10 is a lot for this observation, because not everyone is going to be up front about their steroid abuse."

"This is just the tip of the iceberg," she said."

http://www.steroid.com/side.php
http://www.medscape.com/viewarticle/711781

[terraj]

http://www.*******************.com/a...ey-damage.html

By Dan Gwartney, M.D.

Using Anabolic Steroids: New Study Says Watch for Kidney Damage

The physiology of man evolved such that he maintains optimum health and performance in conditions that are commonly encountered. Over time, man deviated from nature as he established the ability to create shelter against the changing climate; developed trans-geographic commerce to provide a more diverse and stable food supply; and discovered substances that affect the mind and body, such as alcohol and opium.

People in developed countries who enjoy the luxuries of personal vehicles, labor-saving devices, and calorie-laden diets suffer from an epidemic of chronic diseases. Ironically, societies that have achieved the pinnacle of progress through financial and political stability, in addition to scientific advances, appear to erode the physical health of citizens through the promotion of gluttony. Truly, it appears that moderation is the best policy.

Bodybuilders, athletes and fitness extremists pursue not just health, but maximal performance. These individuals are often viewed as the healthiest by the [superficial] general public, but they also experience chronic injury if their training, diet or drug use becomes extreme— tendonitis is a daily experience for many; eating disorders develop; and adverse effects from performance-enhancing drug use/abuse or weight-loss products are unfortunately common.

The most commonly-used class of drugs for sports and physique enhancement is anabolic-androgenic steroids (AAS). From junior high school on, most boys and men become familiar with the multicolor diagram showing a variety of side effects that are implied to be inevitable consequences of AAS use. Of the many organs and systems harmed or damaged by AAS, one paired set of vital organs is easily overlooked— the kidneys.

In the poster "The Harmful Effects of Steroids," a muscular figure is shown hitting a front double biceps pose, while his multicolored innards are penetrated by lines connecting them to a litany of harm caused by AAS. The kidneys are listed with the vague comments of "kidney disease" and "kidney stones," but as they are not visible when the body is viewed from the front, there are no DayGlo-colored organs to go with the statement, not even a connecting line.

Kidney disease and kidney stones are serious matters. The kidneys are vital organs that are taken for granted because most people do not consider their kidneys as long as they are able to urinate— able to pee, worry-free. Yet, when the kidneys begin to fail, serious consequences follow. If the kidneys fail completely, a person will die in days unless he is placed on dialysis.1 Tumors of the kidneys occur, although there is no reported increased risk of cancer in the kidneys in recreational AAS users. One rare cancer of the kidney (Wilms' tumor) has been reported in an AAS user.2

Kidney stones arise in the tiny filtering ducts of the kidney, starting as small crystals, but grow as crystals do until they become lodged and prevent the passage of urine. As spiky, jagged masses, when these crystalline stones dislodge, pray that you are not driving— the pain is equated to the labor pains a mother goes through as she delivers a baby. On a scale of 1 to 10, the pain is often rated as a 10. There are several types and causes of kidney stones; again, no causal association is reported in the medical literature linking AAS use to kidney stones.

AAS Use and Kidney Disease

A possible relationship between recreational AAS use and kidney disease received recent press due to a poster presentation at the American Society of Nephrology.3,4 Pathologist Leal Herlitz, M.D. and colleagues reported their findings relating to the development and progression of a specific form of kidney disease in adult men. Their study compared two groups of men who were diagnosed as having the condition of focal segmental glomerulosclerosis (FSGS). The disorder is characterized by scarring in the cells that filter and secrete waste products into the urine, as well as retaining or reabsorbing essential biomolecules that the body does not want to waste or lose.

FSGS is suspected when kidney function diminishes (as determined by lab tests) and protein is 'spilled' into the urine. Normally, the urine is protein free, but as the filtering units begin to fail, levels of urinary protein increase. When urine protein levels become elevated, the urine will become foamy. Final diagnosis is usually obtained through a kidney biopsy.5

The study groups were composed of 10 men who had admitted to many years of anabolic steroid use (and other performance-enhancing drugs), and 10 men with the condition who were morbidly obese. The initial lab tests demonstrated greater strain and signs of impaired kidney function among the AAS users. Serum (blood) creatinine, the metabolic waste product generated from creatine (yes, the same molecule as the supplement) and cleared from the body by the kidneys, was markedly higher in AAS users (3.0 vs. 1.47 mg/dL— normal serum creatinine range is 0.8 to 1.4 mg/dL). As creatinine can only be secreted by the kidneys, serum concentration rises when the kidneys begin to fail. Urinary protein was also elevated to a significantly greater degree in the AAS-using group as protein 'leaked' into the urine.

When kidney tissue obtained by biopsy was examined under the microscope, the extent of tissue damage was greater in the AAS-users as well, represented by scarring of the glomerular and tubulointerstitial fields (areas involved in filtering urine).

Among the AAS-using men, eight were followed for an average of slightly longer than two years. All eight discontinued AAS use, reduced exercise, and were placed on drug therapy. One rapidly progressed to a dialysis-dependent condition called end stage renal disease. The others showed signs of improvement, with serum creatinine approaching the upper limit of normal, and urinary protein decreasing significantly— although it remained above the normal range seen in healthy people in several of the subjects.

One of the AAS-using subjects became dissatisfied with his body image, claiming he would rather be dialysis-dependent than live without a muscular body. [This would almost certainly qualify the subject for body dysmorphic syndrome. For those nodding in agreement with sacrificing your kidneys to fill an XXXL shirt— trust me, you do not want to become dialysis-dependent.] He went back to using AAS again, despite a history of AAS-related damage. His serum creatinine doubled from near-normal to again being indicative of FSGS. His urinary protein, which had happily cleared down to zero, became elevated to 14 within three and one-half years. At that rate, Dr. Herlitz predicted that he (the AAS-user) could progress to end stage renal disease in another four to five years.

This comparison suggested to Dr. Herlitz that AAS contribute to kidney damage. She proposed that in addition to supporting a greater body mass and placing greater stress on the kidneys, AAS may also have a direct toxic effect on the cells. Dr. Herlitz noted that creatinine is primarily produced in skeletal muscle, so logically a person with greater muscle mass will have elevated serum creatinine compared to a sedentary person, even if they are of similar weight. Furthermore, the higher dietary protein intake common to athletes and bodybuilders, as well as exercise-related hypertension (high blood pressure during physical exertion), can promote injury to the glomerular units of the kidney.

Other Factors Affect Your Kidneys

From the presentation, one might conclude that AAS are at least associated with a greater risk of kidney damage, and potentially may play both a direct and indirect role in harming that vital, paired set of organs. Further, the damage being done appears to be particularly virulent when compared to the control group used in this study, the morbidly obese (average BMI >40). However, FSGS is a non-specific finding present in a variety of conditions, and secondary to a number of known causes. The control group may or may not have been appropriately matched to the AAS-using group, as BMI cannot be used as an approximation for lean body mass, sometimes referred to as fat-free mass index.

Other known agents or conditions that may affect kidney status were not accounted for, so far as the press reports of this study revealed. Among the many factors that are associated with this form of kidney damage (i.e., use of opiate drugs, hypertension, hepatitis B, HIV, etc.), several have been reported in AAS users.6-9 Ibuprofen (e.g., Advil) has been associated with kidney damage, but a different form than FSGS.

Among the many drugs commonly used in conjunction with AAS, FSGS has been reported in a woman being treated for breast cancer with anastrozole.10 This drug, known by the brand name Arimidex, is often used in conjunction with AAS as it inhibits the enzyme aromatase. Using anastrozole, or related drugs, is common in AAS users wishing to self-treat or avoid estrogen-related side effects (many AAS are converted into estrogens by the enzyme aromatase). It is possible that the use of aromatase inhibitors or non-aromatizing AAS may be a significant factor in FSGS, or it may not be an issue at all. It is just too early to discern the factors related to AAS-associated kidney damage.

What is revealed by this study is that at least one type of kidney damage (FSGS) is related to AAS use. The presence of FSGS in AAS users is not proof of the drugs' causing or worsening the disease. The concentration of the disease in such a small geographic area, among a limited population, appears to be greater than one might suspect. The news release did not clarify the period when these cases appeared. The fact that the condition was resolved, at least partially when the men ceased using AAS, supports the possible involvement of AAS in the development or progression of FSGS. Another convincing observation was the case of the gentleman who returned to AAS use after his lab tests returned to normal, only to see the condition return and worsen with continued AAS use.

What does this report mean in terms of recreational AAS use? It should serve as a reminder that these are powerful drugs, and along with the benefits of greater strength and muscle mass, one also is exposed to the risk of any number of side effects. Few people take the time (and expense) of being screened for pre-existing conditions prior to using AAS. Few monitor the function of vital organs during and following AAS use to ensure that adverse side effects are not developing.

In addition to liver damage, psychological/mood disorders, changes in blood lipids, etc., AAS users should consider the potential for damaging their kidneys. Those who use AAS recreationally should have their kidney function checked prior to starting a cycle (preferably before the first cycle) by measuring serum (blood) levels of BUN and creatinine, as well as urine protein, including the sensitive microalbuminuria test.

AAS users should monitor their urine, looking for the development of foamy urine; purchasing urine dipsticks that will detect the presence of protein in the urine is even better. These urine dipsticks can be purchased online, but the use is no substitute for professional medical supervision and is no guarantee of safety.

Individuals who use AAS never want to hear of risks, dangers, injury, etc. There are many. AAS can be used safely but not indiscriminately. Placing these drugs in the hands of untrained and risk-seeking individuals is tantamount to harm. It is the cavalier attitude of many users that supports AAS legislation and restrictions on medical professionals.

Choosing to use AAS for performance enhancement or physique augmentation is viewed by many as a personal liberty, despite the legal disincentives. Regardless of one's philosophical stance, those choosing to use any drug, diet or technology need to do so in an informed manner. The revelation of kidney strain/damage in a representative group of AAS users needs to be considered during the decision process. Those who eventually use AAS need to be aware of the need to monitor the health and function of the kidneys, in addition to other potential risks.

References:

1. Hsu CY, Ordonez JD, et al. The risk of acute renal failure in patients with chronic kidney disease. Kidney Int, 2008 July;74(1):101-107.

2. Prat J, Gray GF, et al. Wilms tumor in an adult associated with androgen abuse. JAMA, 1977 May 23;237(21):2322-3.

3. Herlitz L, et al. "Development of FSGS following anabolic steroid use in bodybuilders." ASN, 2009; Abstract TH-PO163.

4. Neale T. ASN: Anabolic Steroid Abuse May Damage Kidneys. Medpage Today, 2009 Oct 30. Available at http://www.medpagetoday.com/tbindex.cfm?tbid=16705, accessed November 9, 2009.

5. Thomas DB. Focal segmental glomerulosclerosis: a morphologic diagnosis in evolution. Arch Pathol Lab Med, 2009 Feb;133(2):217-23.

6. Wines JD Jr, Gruber AJ, et al. Nalbuphine hydrochloride dependence in anabolic steroid users. Am J Addict, 1999 Spring;8(2):161-4.

7. Grace F, Sculthorpe N, et al. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids (AAS). J Sci Med Sport, 2003 Sep;6(3):307-12.

8. Crampin AC, Lamagni TL, et al. The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales. Epidemiol Infect, 1998 Oct;121(2):381-6.

9. Bolding G, Sherr L, et al. Use of anabolic steroids and associated health risks among gay men attending London gyms. Addiction, 2002 Feb;97(2):195-203.

10. Kalender ME, Sevinc A, et al. Anastrozole-associated sclerosing glomerulonephritis in a patient with breast cancer. Oncology, 2007;73(5-6):415-8.

[terraj]

What can be done about CKD?
Unfortunately, CKD often cannot be cured. But people in the early stages of CKD may be able to make their kidneys last longer by taking certain steps. They will also want to minimize the risks for heart attack and stroke because CKD patients are susceptible to these problems.

•People with reduced kidney function should see their doctor regularly. The primary doctor may refer the patient to a nephrologist, a doctor who specializes in kidney disease.
•People who have diabetes should watch their blood glucose levels closely to keep them under control. They should ask their health care provider about the latest in treatment.
•People with reduced renal function should avoid pain pills that may make their kidney disease worse. They should check with their health care provider before taking any medicine.
Controlling Blood Pressure
People with reduced kidney function and high blood pressure should control their blood pressure with an ACE inhibitor or an ARB. Many people will require two or more types of medication to keep their blood pressure below 130/80. A diuretic is an important addition when the ACE inhibitor or ARB does not meet the blood pressure goal.

Changing the Diet
People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.

Protein. Protein is important to the body. It helps the body repair muscles and fight disease. Protein comes mostly from meat but can also be found in eggs, milk, nuts, beans, and other foods. Healthy kidneys take wastes out of the blood but leave in the protein. Impaired kidneys may fail to separate the protein from the wastes.

Some doctors tell their kidney patients to limit the amount of protein they eat so the kidneys have less work to do. But a person cannot avoid protein entirely. People with CKD can work with a dietitian to create the right food plan.

Cholesterol. Another problem that may be associated with kidney failure is high cholesterol. High levels of cholesterol in the blood may result from a high-fat diet.

Cholesterol can build up on the inside walls of blood vessels. The buildup makes pumping blood through the vessels harder for the heart and can cause heart attacks and strokes.

Sodium. Sodium is a chemical found in salt and other foods. Sodium in the diet may raise a person’s blood pressure, so people with CKD should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.

Potassium. Potassium is a mineral found naturally in many fruits and vegetables, such as oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in the blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium. With very poor kidney function, high potassium levels can affect the heart rhythm.

http://kidney.niddk.nih.gov/Kudiseas...idneys/#stages

[200gamblr]

Thanks terraj - that was a great read.