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Steroids, creatine and high-protein diet can cause kidney damage if you don't drink enough

Pharmacological bodybuilders with a high protein intake need to make sure they take in enough liquid during periods of hot weather. If they don't, they run the risk of kidney damage, according to an article published by researchers at Hawler College of Medicine in Iraq. They describe four cases of serious kidney damage in bodybuilders.

Steroids, proteins and creatine
The four protagonists in the study, which has been published in Clinical Kidney Journal, were men aged between 20 and 26. They had sought medical advice because they were unusually lacking in energy and tired.

All of the bodybuilders used anabolic steroids, including nandrolone decanoate and testosterone propionate, which they injected. The researchers do not reveal the exact dosages, but say that the men had been injecting themselves with more than 400 mg of steroids each week.

In addition, the men had been taking protein supplements and creatine. They consumed 78-104 g protein a day. In total the men consumed 3.2-4.2 g protein per kg bodyweight per day. And on top of that the men took 15 g creatine every day.

Kidney damage
Steroids, creatine and high-protein diet can cause kidney damage if you don't drink enough
When the researchers analysed blood samples from the men, they found evidence of kidney damage. The bodybuilders' creatinine levels were too high and their estimated glomerular filtration rate was too low. The researchers took biopsies from the bodybuilders' kidneys and found calcium depositions and dead tissue.

Kicking the habit
The researchers got the bodybuilders to stop taking the supplements and steroids they had been using. This helped. After six months, although it hadn't returned to normal, their kidney functioning was much improved.

Normal creatinine levels for men are between 60 and 110 micromoles per litre.

Steroids, creatine and high-protein diet can cause kidney damage if you don't drink enough

A measurement that gives much more information is the estimated glomerular filtration rate. The lower this is, the less blood the kidneys are able to filter and clean. The bodybuilders' estimated glomerular filtration rate at the beginning was 22-34 millilitres per minute. That's an alarmingly low level, as the table below shows.

Steroids, creatine and high-protein diet can cause kidney damage if you don't drink enough

After the bodybuilders had spent six months off supplements and steroids, their estimated glomerular filtration rate had risen to over 60 millilitres per minute.

Possible explanation
The researchers don't think that the steroids, proteins and creatine themselves had caused the kidney damage, but that this had probably been caused by the long, intensely hot summers in Iraq.

"There is concern that excess dietary protein and creatine that is not accompanied by increased fluid intake may lead to a relative hypovolemia", the researchers wrote. "The clinical presentation of our three of our patients was in the summer. Iraqi summers are very hot, and by Western standards, the regional gymnasiums are warm and trainee hydration less than optimal."

"We must emphasize that a specific offending agent cannot be identified in this case material, and it may be the combination of excess creatine and protein with steroid injections that compounds risk not incurred with the individual substances."

"Our working hypothesis is that under hydration rather than direct toxicity precipitated the kidney injury."

Clin Kidney J. 2015;8(4):415-9.

Creatine and protein-rich diet combination not dangerous for kidneys 05.07.2013