title: The cost of seeking an edge: Recurrent renal infarction in setting of recreational use of anabolic steroids.
abstract: BACKGROUND
  Anabolic-androgenic steroid (AAS) use and testosterone therapy have been well established risk factors for the creation of a pro-thrombotic state, and to precipitate formation of thromboemboli in individuals already predisposed to thrombosis.
  
  
  METHODS
  Here, we present the case of an amateur bodybuilder, with a negative thrombophilia workup, who experienced primary renal infarction while using the AAS trenbolone acetate and testosterone, as well as a subsequent renal infarction while anticoagulated with apixaban.
  
  
  CONCLUSIONS
  The development of subsequent infarctions in an anticoagulated patient with discontinued recreational steroid use poses a unique situation and challenges the current understanding of a thrombophilic state associated with steroids. The lifetime prevalence of anabolic steroid use is estimated to be 1% in the male population in the United States which is significant.
  
  
  CONCLUSIONS
  Further understanding and recommendations of appropriate anticoagulant should be further elucidated to appropriately medically manage patients from this confounding social and medical history.
authors.affiliation: Pinnacle Health System, Department of Internal Medicine, Harrisburg, PA, United States.
authors.forename: Shaun
authors.initials: S
authors.lastname: Colburn
authors.affiliation: Pinnacle Health System, Department of General Surgery, Harrisburg, PA, United States.
authors.forename: W Kurtis
authors.initials: WK
authors.lastname: Childers
authors.affiliation: Pinnacle Health System, Department of Internal Medicine, Harrisburg, PA, United States.
authors.forename: Alex
authors.initials: A
authors.lastname: Chacon
authors.affiliation: Pinnacle Health System, Department of Internal Medicine, Harrisburg, PA, United States.
authors.forename: Alexa
authors.initials: A
authors.lastname: Swailes
authors.affiliation: Pinnacle Health System, Department of Internal Medicine, Harrisburg, PA, United States.
authors.forename: Fauzan M
authors.initials: FM
authors.lastname: Ahmed
authors.affiliation: Pinnacle Health System, Department of Internal Medicine, Harrisburg, PA, United States.
authors.forename: Rajinder
authors.initials: R
authors.lastname: Sahi
keywords: Anabolic; Renal artery thrombus; Renal infarction; Steroids