title: Acute bile nephropathy secondary to anabolic steroids.
abstract: Renal dysfunction in cholestatic liver disease is multifactorial. Acute kidney injury may develop secondary to renal vasoconstriction in the setting of peripheral vasodilation and relative hypovolemia, tubular obstruction by bile casts, and direct tubular toxicity from bile. Anabolic steroids are frequently used by athletes to boost endurance and increase muscle mass. These agents are a recently recognized cause of hepatotoxicity and jaundice and may lead to acute kidney injury. To increase awareness about this growing problem and to characterize the pathology of acute kidney injury in this setting, we report on a young male who developed acute kidney injury in the setting of severe cholestatic jaundice related to ingestion of anabolic steroids used for bodybuilding. Kidney biopsy showed bile casts within distal tubular lumina, filamentous bile inclusions within tubular cells, and signs of acute tubular injury. This report supports the recently re-emerged concept of bile nephropathy cholemic nephrosis.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Alkhunaizi
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: ElTigani
authors.forename: Rola S
authors.initials: RS
authors.lastname: Rabah
authors.forename: Samih H
authors.initials: SH
authors.lastname: Nasr
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000473:pathology; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects*; D001646:Bile / Q000737:chemistry / Q000187:drug effects*; D001647:Bile Acids and Salts / Q000032:analysis; D001663:Bilirubin / Q000097:blood; D001706:Biopsy / Q000379:methods; D002976:Clenbuterol / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D006801:Humans; D041781:Jaundice, Obstructive / Q000139:chemically induced*; D007684:Kidney Tubules / Q000737:chemistry / Q000187:drug effects; D008297:Male; D010074:Oxandrolone / Q000009:adverse effects; D013197:Stanozolol / Q000009:adverse effects; D013739:Testosterone / Q000009:adverse effects / Q000031:analogs & derivatives; D014284:Triiodothyronine / Q000627:therapeutic use; D014891:Weight Lifting
chemical_list: D000318:Adrenergic beta-Agonists; D045930:Anabolic Agents; D000728:Androgens; D001647:Bile Acids and Salts; D014284:Triiodothyronine; D013739:Testosterone; D013197:Stanozolol; D010074:Oxandrolone; D003404:Creatinine; D001663:Bilirubin; D002976:Clenbuterol; C001371:boldenone undecylenate