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Gym Nephropathy
Bodybuilding vs. Kidney Damaging
Mohammed Abdel Gawad
Nephrologist - Kidney & Urology Center (KUC) - Alexandria
Board Member of Egyptian Society of Nephrology & Transplantation
Founder & Chairman of NephroTube
To get the presentation with full animations and
videos please contact me on
drgawad@gmail.com
For more presentations visit
www.NephroTubeCNE.com
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Weak Soft Evidence
‱ Small number of patients were
tested by different studies
‱ Conflicting and contradictory results
‱ Short time of follow up
‱ Lack of head-to-head comparisons
among different agents
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
2010 Jan; 21(1): 163–172
2010 Jan; 21(1): 163–172
2010 Jan; 21(1): 163–172
AASs Stopped + Supportive treatment ± Steroids
2010 Jan; 21(1): 163–172
2010 Jan; 21(1): 163–172
2010 Jan; 21(1): 163–172
2001 Jan;16(1):163-5
A 27‐year‐old man
‱ High‐protein commercial diet with more than 2 g/kg body
weight/day containing:
 L‐glutamine 33.3 g
 taurine 33.3 g
 creatine 210 g
‱ AAS (testosterone) 750–1000 mg/week at 6‐week intervals
‱ Clenbuterol (tablets) t.d.s.
for 18 months
2001 Jan;16(1):163-5
Renal Biopsy
Global glomerulosclerosis in 10/12 glomeruli
+ diffuse chronic tubulo-interstitial damage
Tubulo-Interstitial Nephritis / FibrosisGlobal Sclerosis
2001 Jan;16(1):163-5
Renal Biopsy
Global glomerulosclerosis in 10/12 glomeruli
+ diffuse chronic tubulo-interstitial damage
+ Vascular occlusion
2014;64(3):473-476
6 weeks prior to evaluation:
- anabolic androgenic steroids (nandrolone injection,
testosterone injection, oral methandrostenolone)
- supplements and protein shakes.
Acute onset of jaundice, fatigue, loss of appetite, unintentional
weight loss, pruritus, clay-colored stools, and dark urine
At day 9, renal impairment started to appear
A 41-year-old man
2014;64(3):473-476
6 weeks prior to evaluation:
- anabolic androgenic steroids (nandrolone injection,
testosterone injection, oral methandrostenolone)
- supplements and protein shakes.
Acute onset of jaundice, fatigue, loss of appetite, unintentional
weight loss, pruritus, clay-colored stools, and dark urine
At day 9, renal impairment started to appear
A 41-year-old man
2014;64(3):473-476
6 weeks prior to evaluation:
- anabolic androgenic steroids (nandrolone injection,
testosterone injection, oral methandrostenolone)
- supplements and protein shakes.
Acute onset of jaundice, fatigue, loss of appetite, unintentional
weight loss, pruritus, clay-colored stools, and dark urine
At day 9, renal impairment started to appear
A 41-year-old man
2014;64(3):473-476
6 weeks prior to evaluation:
- anabolic androgenic steroids (nandrolone injection,
testosterone injection, oral methandrostenolone)
- supplements and protein shakes.
Acute onset of jaundice, fatigue, loss of appetite, unintentional
weight loss, pruritus, clay-colored stools, and dark urine
At day 9, renal impairment started to appear
A 41-year-old man
2014;64(3):473-476
2014;64(3):473-476
2018;41:10-131 Feb 2018
Supplement What would I tell my patient?
Anabolic steroids Totally harmful
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
2013 May 16;10(1):26
Creatine (20 g/d for 5 d
followed by 5 g/d
throughout the trial)
High-protein diet
(≄ 1.2 g/Kg/d)
2013 May 16;10(1):26
2013 May 16;10(1):26
Is Creatine safe on kidneys?
32-year-
old man
Creatine for 3 wks
(20 g/d for 3 days
and maintenance
dose of 1 g/d)
Nausea and
weakness
Serum urea; 111
mg/dL
Serum creatinine
4.3 mg/dL
32-year-
old man
Creatine for 3 wks
(20 g/d for 3 days
and maintenance
dose of 1 g/d)
Nausea and
weakness
Serum urea; 111
mg/dL
Serum creatinine
4.3 mg/dL
32-year-
old man
Creatine for 3 wks
(20 g/d for 3 days
and maintenance
dose of 1 g/d)
Nausea and
weakness
Serum urea; 111
mg/dL
Serum creatinine
4.3 mg/dL
After starting corticosteroid therapy →
serum creatinine level decreased to 1.8 mg/dL
18-year-
old man
Creatine for 6 wks
(20 g/day for 5
days and
maintenance 1
g/day)
Nausea and
weakness
- serum urea
39.98 mmol/L
- serum creatinine
201.55 mmol/L
- daily protein
excretion was 284
mg
2011 Feb; 4(1): 23–24
2011 Feb; 4(1): 23–24
2011 Feb; 4(1): 23–24
Stopping creatine
Proteinuria
normalized
Supplement Comment
Anabolic steroids Totally harmful
Creatine Generally safe (but cases of AKI
had been reported)
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
22-
year-
old man
Nausea, vomiting,
and upper
abdominal pain
Acute pancreatitis
& Renal failure
Hypercalcemia
2014 May;85(5):1247-8
22-
year-
old man
Nausea, vomiting,
and upper
abdominal pain
Acute pancreatitis
& Renal failure
Hypercalcemia
History: Monthly IM 50ml of cholecalciferol
(each ml contains 50,000 UI ) →
to improve muscle gain in the past 2 years
2014 May;85(5):1247-8
2014 May;85(5):1247-8
Nephrocalcinosis secondary to
exogenous vitamin D intoxication
2014 May;85(5):1247-8
2014 May;85(5):1247-8
2017 Oct-Dec;39(4):467-469
2017 Jan - Feb;37(1):61-67
Supplement Comment
Anabolic steroids Totally harmful
Creatine Generally safe (but cases of AKI had
been reported)
Vitamins Must be used only in evidence of
their deficiency or within daily
recommended requirements
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Afferent Arteriole Efferent Arteriole
↑
Intraglomerular
Pressure
2014;14(9):523 www.NephroTubeCNE.com
FSGS
Global Sclerosis
Afferent
Arteriole
Efferent
Arteriole
↑
Intraglomerular
Pressure
Tubulo-Interstitial fibrosis
2016 Jan 16;13:3
12 healthy resistance-trained
2016 Jan 16;13:3
Volume 2016 (2016), Article ID 9104792
14 healthy resistance-trained
2 months 4 months 2 months 4 months
Volume 2016 (2016), Article ID 9104792
What should I tell my patient
regarding protein supplements?
They are not safe if you have a kidney
disease
They are generally safe if you have healthy
kidneys (but long term effect over years is
not known)
Don’t use if you have kidney stone or a
history of it
2004 Dec;44(6):950-62
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
40-year-old man
2- to 3-week history of daily ingestion of 100 to 120 oz of Red Bull energy drink
2014 Oct;48(10):1366-70
Red Bull intake stopped
Supplement Comment regarding renal effect
Anabolic steroids Totally harmful
Creatine Generally safe (but cases of AKI had
been reported)
Vitamins Must be used only in evidence of
their deficiency or within daily
recommended requirments
Protiens Not safe if you have a kidney disease
Generally safe if healthy kidneys (but
long term effect is not known)
Don’t use if kidney stone or a history
of it
Energy drinks Generally safe (but cases of AKI had
been reported)
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Non Nutritional
Supplements
Nutritional
Supplements
Anabolic Steroids Creatine
GH Vitamins
IGF Protein (Whey, Casein
..)
L-Thyroxine Amino Acids / BCAA
Beta 2 Agonist Glutamine
Antiestrogens L-arginine
Aromatase Inhibitors Pre-work out: Energy Drinks
Beta HCG L-carnitine
Erythropoietin Liver Albumin
Omega 3
Take Care..!!
Creatinine 
 Not that accurate tool
Creatinine (Cr)
Normal Cr? According to Muscle Mass?
Serum Cr 1.6mg/dl Serum Cr 1.6mg/dl
Home Messages
Supplement Comment regarding renal effect
Anabolic steroids Totally harmful
Creatine Generally safe (but cases of AKI had been
reported)
Vitamins Must be used only in evidence of their
deficiency or within daily recommended
requirements
Proteins
Not safe if you have a kidney disease
Generally safe if healthy kidneys (but
long term effect is not known)
Don’t use if kidney stone or a history of it
Energy drinks Generally safe (but cases of AKI had been
reported)
Workshop Recommendation
Sport Supplements & Health
‱ Endocrinologist
‱ Hepatologist
‱ Cardiologist
‱ Pulmonolgist
‱ Diabetologist
‱ Neurologist
‱ Dermatologist
‱ Nephrologist
‱ Nutritionist
Research Recommendations
1. Large number of participants.
2. Longer periods of follow up.
3. Administration of one supplement
per group to be sure of its effect.
4. Biopsy is mandatory to detect
subclinical cases.
Thank You

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