This document discusses various supplements used by bodybuilders and their potential effects on kidney health. It notes that anabolic steroids can be totally harmful to the kidneys. Creatine is generally safe for most people but there have been some reported cases of acute kidney injury. Vitamins should only be used if there is a documented deficiency and within daily recommended limits to avoid potential kidney damage from excess intake. Protein supplements are generally safe for those with healthy kidneys but long term effects are unknown and they should be avoided by those with kidney disease or risk of kidney stones. Energy drinks have also been associated with some acute kidney injury cases but are usually safe when consumed in moderation.
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Gym nephropathy (bodybuilding vs. kidney damaging) - Dr. Gawad
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. To get the presentation with full animations and
videos please contact me on
drgawad@gmail.com
For more presentations visit
www.NephroTubeCNE.com
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. 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. 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. 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
14. 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
15. 2001 Jan;16(1):163-5
Renal Biopsy
Global glomerulosclerosis in 10/12 glomeruli
+ diffuse chronic tubulo-interstitial damage
Tubulo-Interstitial Nephritis / FibrosisGlobal Sclerosis
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. 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. 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. 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
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
33. 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
34. 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
35. 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
42. 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
48. 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
49. 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
50. 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
58. What should I tell my patient
regarding protein supplements?
59. 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
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. 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. 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. 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. 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. 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
67. 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
68. 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
69. 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)
70. 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
71. 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
77. 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)
79. 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.