Secondary Focal Segmental Glomerulosclerosis In Bodybuilders

Research Article
Ahmed Ramadan Ali, Sherif H.Maroof , Hussein S. Hussein, Ahmed Alsayed4, Esmat Fawzy , John Patrick Madda FRC path
Focal segmental glomerulosclerosis, bodybuilders, androgen anabolic steroids.

Background: Many athletes use high protein diet, high pharmacological doses of androgen anabolic steroids (AASs), growth hormone to enhance their physique, improve achievements. The(AASs)are banned for their effects on immune system, blood, sterility, atherosclerosis, blood pressure, heart, liver, and secondary focal and global glomerulosclerosis. Objectives: identify pattern, risk factors, etiology, histopathological features, prognosis and management of renal involvement in bodybuilders. Patients and Methods: This study enrolled (33) male body builders who developed impaired kidney functions, proteinuria and were followed up for (1) year. All patients were subjected to clinical examination, recording of( body mass index(BMI), training sessions/ week, duration, protein intake per/day, creatine and amino acids intake /day, AASs, growth hormone intake/week).Laboratory investigations{HCV antibody, HBV surface and core Ag, HIVAb}, {ANA, anti-ds DNA,C3,C4,CH50}, {serum creatinine, BUN}, total proteins, serum albumin, urine analysis, quantitative 24 hours urinary proteinuria, lipid profile, {ALT,AST}, serum calcium, phosphorus, total vitamin D, serum PTH, TSH and hemoglobin levels. Renal biopsy was performed for all participants and estimated glomerular filtration rate (eGFR)was done. Results: Association of secondary focal segmental glomerulosclerosis (FSGS) in 33 bodybuilders; mean age (31.42y± 1.44), mean BMI (46.18 kg/m2 ±2.51) after long-term abuse of AASs with mean intake (1827.27 mg/wk ±426.66). Clinical presentation included renal insufficiency, mean serum creatinine (527.79 ummol/l ±231), mean proteinuria (19.30 g/d.±5.24). Renal biopsy revealed FSGS and end stage renal disease (ESRD) glomerulomegaly in 33 patients, with tubular atrophy and interstitial fibrosis in 21 of them. Upon follow-up; 12 patients progressed to ESRD and required renal replacement therapy (RRT); 3 were non compliant to medical advice, 9 started (RRT) at time of diagnosis. All patients were prescribed renin-angiotensin system blockers, advised to discontinue (AASs) leading to weight loss, stabilization or improvement in serum creatinine, reduction in proteinuria in the remaining 21 patients. Conclusion: Increased BMI, abuse of (ASSs), high protein diet carry a great risk for developing ESRD secondary to (FSGS) in bodybuilders.