Nutritional and non-nutritional strategies in bodybuilding: Impact on kidney function

Abstract

Bodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. Thus, a structured narrative review of the literature was performed. The search strategy and parameters identifying areas of importance closely followed the PRISMA statement guidelines. This resulted in 13 relevant full-text articles consisting of 8 case reports and 5 case series, published since 2000. Kidney disease was described in 75 bodybuilders, with diagnoses ranging from acute kidney injury (AKI), acute tubular necrosis , focal segmental glomerular sclerosis (FSGS), nephrocalcinosis, acute interstitial nephritis , nephrosclerosis, chronic interstitial nephritis, an assortment of other glomerulonephritides. The development of AKI, FSGS and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advice.