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Gym nephropathy (bodybuilding vs. kidney damaging)

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Gym nephropathy (bodybuilding vs. kidney damaging)

  1. 1. 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
  2. 2. To get the presentation with full animations and videos please contact me on drgawad@gmail.com For more presentations visit www.NephroTubeCNE.com
  3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 2010 Jan; 21(1): 163–172
  8. 8. 2010 Jan; 21(1): 163–172
  9. 9. 2010 Jan; 21(1): 163–172
  10. 10. AASs Stopped + Supportive treatment ± Steroids 2010 Jan; 21(1): 163–172
  11. 11. 2010 Jan; 21(1): 163–172
  12. 12. 2010 Jan; 21(1): 163–172
  13. 13. 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
  14. 14. 2001 Jan;16(1):163-5 Renal Biopsy Global glomerulosclerosis in 10/12 glomeruli + diffuse chronic tubulo-interstitial damage Tubulo-Interstitial Nephritis / FibrosisGlobal Sclerosis
  15. 15. 2001 Jan;16(1):163-5 Renal Biopsy Global glomerulosclerosis in 10/12 glomeruli + diffuse chronic tubulo-interstitial damage + Vascular occlusion
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 2014;64(3):473-476
  21. 21. 2014;64(3):473-476
  22. 22. 2018;41:10-131 Feb 2018
  23. 23. Supplement What would I tell my patient? Anabolic steroids Totally harmful
  24. 24. 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
  25. 25. 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
  26. 26. 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)
  27. 27. 2013 May 16;10(1):26
  28. 28. 2013 May 16;10(1):26
  29. 29. Is Creatine safe on kidneys?
  30. 30. 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
  31. 31. 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. 32. 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
  33. 33. 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
  34. 34. 2011 Feb; 4(1): 23–24
  35. 35. 2011 Feb; 4(1): 23–24 Stopping creatine Proteinuria normalized
  36. 36. Supplement Comment Anabolic steroids Totally harmful Creatine Generally safe (but cases of AKI had been reported)
  37. 37. 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
  38. 38. 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
  39. 39. 22- year- old man Nausea, vomiting, and upper abdominal pain Acute pancreatitis & Renal failure Hypercalcemia 2014 May;85(5):1247-8
  40. 40. 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
  41. 41. 2014 May;85(5):1247-8
  42. 42. Nephrocalcinosis secondary to exogenous vitamin D intoxication 2014 May;85(5):1247-8
  43. 43. 2014 May;85(5):1247-8
  44. 44. 2017 Oct-Dec;39(4):467-469
  45. 45. 2017 Jan - Feb;37(1):61-67
  46. 46. 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
  47. 47. 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
  48. 48. 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
  49. 49. Afferent Arteriole Efferent Arteriole ↑ Intraglomerular Pressure 2014;14(9):523 www.NephroTubeCNE.com
  50. 50. FSGS Global Sclerosis
  51. 51. Afferent Arteriole Efferent Arteriole ↑ Intraglomerular Pressure Tubulo-Interstitial fibrosis
  52. 52. 2016 Jan 16;13:3 12 healthy resistance-trained
  53. 53. 2016 Jan 16;13:3
  54. 54. Volume 2016 (2016), Article ID 9104792 14 healthy resistance-trained 2 months 4 months 2 months 4 months
  55. 55. Volume 2016 (2016), Article ID 9104792
  56. 56. What should I tell my patient regarding protein supplements?
  57. 57. 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
  58. 58. 2004 Dec;44(6):950-62
  59. 59. 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
  60. 60. 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
  61. 61. 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
  62. 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
  63. 63. 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
  64. 64. 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
  65. 65. 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
  66. 66. 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
  67. 67. 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)
  68. 68. 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
  69. 69. 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
  70. 70. Take Care..!! Creatinine … Not that accurate tool
  71. 71. Creatinine (Cr) Normal Cr? According to Muscle Mass? Serum Cr 1.6mg/dl Serum Cr 1.6mg/dl
  72. 72. Home Messages
  73. 73. 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)
  74. 74. Workshop Recommendation Sport Supplements & Health • Endocrinologist • Hepatologist • Cardiologist • Pulmonolgist • Diabetologist • Neurologist • Dermatologist • Nephrologist • Nutritionist
  75. 75. 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.
  76. 76. Thank You

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