title: Acute kidney injury due to anabolic steroid and vitamin supplement abuse: report of two cases and a literature review.
abstract: BACKGROUND
  The use of anabolic steroids and vitamin supplements has reached alarming proportions in the last decades. Adverse effects have been documented and include virilization, feminization, adverse lipid profile, psychiatric disorders, cardiac and liver disease. Acute kidney injury (AKI) is not frequently described. The purpose of this study is to report two cases of AKI associated with anabolic steroid and vitamin supplement abuse.
  
  
  METHODS
  Two men, aged 21 and 30 years, presented to the Emergency Department with abdominal pain, nausea and vomiting. They reported the use of anabolic steroids and veterinary supplements with vitamins A, D and E. Laboratory tests showed AKI (serum urea 79 and 52 mg/dl, serum creatinine 3.9 and 1.9 mg/dl) and hypercalcemia (calcium 13.2 and 11 mEq/l). Kidney biopsies showed inflammatory interstitial nephritis and acute tubular necrosis. Treatment consisted of vigorous hydration with simultaneous use of furosemide and discontinuation of the vitamins and anabolic substances, and resulted in recovery of renal function.
  
  
  CONCLUSIONS
  AKI is an important complication of anabolic steroid and vitamin supplement abuse. The exact pathophysiology of this type of AKI remains unclear. The main cause of renal dysfunction in these cases seems to be the vitamin D intoxication and drug-induced interstitial nephritis. It is mandatory to start early treatment for serious hypercalcemia, with vigorous venous hydration, diuretics and corticosteroids.
authors.affiliation: Division of Nephrology, Hospital Geral de Fortaleza, Secretaria da Saúde do Estado do Ceará, Fortaleza, CE, Brazil. ef.daher@uol.com.br
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Júnior
authors.forename: Anaiara L
authors.initials: AL
authors.lastname: Queiroz
authors.forename: Lysiane M A
authors.initials: LM
authors.lastname: Ramos
authors.forename: Silvia Q
authors.initials: SQ
authors.lastname: Santos
authors.forename: Dulce M S
authors.initials: DM
authors.lastname: Barreto
authors.forename: Antonio Augusto C
authors.initials: AA
authors.lastname: Guimarães
authors.forename: Célio A
authors.initials: CA
authors.lastname: Barbosa
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Franco
authors.forename: Régia M S V
authors.initials: RM
authors.lastname: Patrocínio
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013256:Steroids / Q000009:adverse effects*; D014815:Vitamins / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D013256:Steroids; D014815:Vitamins