MULTIPLE IN MEMORIAM

Glomerulus of a nephron showing sclerosis in the centre
Glomerulus of a nephron showing sclerosis in the centre





I hesitated for a long time

before choosing  the language

for this blog article.

I think more people might "benefit"

from it if it be written in English. 

 

 






I've not always been a winemaker. In a previous life, kidney diseases were both my occupation and my competence.

At least, I hope so.

 

In January 2010, the Journal of the American Society of Nephrology, a highly regarded medical newspaper, published an article* setting a link between anabolic steroids and a peculiar form of renal disease. The article is well documented - as should be after being accepted by a peer review and not advertising any particular drug, a frequent and tricky bias - and the evidence is convincing. Only, the very first sentence of the abstract is a statement that annoys me: "Anabolic steroid abuse adversely affects .... but renal injury has not been described". It may be true that no scientific team had ever published on this topic at the time, with clear evidence, but any nephrologist you may interview will know of at least one case of increasing alteration of the renal function in "top athletes". Of course, the link between high-level competition and doping has been taboo for ages, and lawyers will gladly prosecute anyone touching upon this matter without overcompelling material. The producers of steroids are only too glad to flog their poison, the physicians (or veterinary doctors or physiotherapists, for that matter) earn good money, and the trainers and/or team-managers want to be on the winning side. The athlete is only a victim, if you ask me.

 

The article, rightly so, states that the very beginning of the disease goes unnoticed because of a well known feature: increase of basal serum creatinine level in case of increase in muscle mass and "meager body weight". This parameter is the routine test to assess renal function. Although gross, not very much is at stake as long as it remains "normal", most physicians will think. It is not strictly true, but still. When serum creatinine increases, it means, mostly, that our kidneys are not able to get rid of it fast enough. But in body-builders, in highly-trained muscular athletes, in individuals eating a lot of proteins, a slight increase just evidences an elevated synthesis of the stuff. This may be misleading.

 

The renal lesion detailed in the article, focal segmental glomeruloscerosis (Hyalinose segmentaire et focale in French) can be caused by multiple factors, one of which being adaptative reaction to "over-pressure" in the kidney. Every single little unit, called a nephron, which is the "filter" of the kidney, will first develop to handle this overload, and will become hypertrophic. At a later stage, it will become stiff, thick and less effective: sclerosis is ongoing. Once this situation is established, renal function will decrease overall, the patient will start losing proteins and both nephrotic syndrome and renal failure will develop, leading to hemodialysis. 

 

My personal anecdote is a sad one. One of the young patients which I followed during my terms in teaching hospitals in Brussels had had to be admitted on a chronic hemodialysis program, because he suffered end-stage renal failure as a result of severe arterial hypertension, on the one hand, but also because he had put his kidneys under a very severe stress. He was a former Belgian body-building champion, still competing and possessing a training hall at his own home,  eating colossal amounts of meat (and eggs, incidentally). He was particularly keen on chicken, having 3 or 4 of them for breakfast, on beef, eating huge amounts of steak, and made omelettes with 6 to 8 large eggs every time! I don't remember the details of his renal lesions - I'm not even certain a biopsy was taken as the situation was past recovery when he first seeked medical help - but he may well have been such a case. It would fit the clinical picture. I have no clue as to his consumption of any food  "additive" or more toxic substances, but insist that even the banal creatine (attention, different from creatinine!) is noxious.

 

Beside the absorption of steroids, the deleterious effect of erythropoietin in excess on renal function is also well known, and is based on different mechanisms. Even simple everyday anti-inflammatory drugs, some of them delivered "over-the-counter", and taken in case of tendons or joints injuries, so frequent in sport, deeply distort the pressure equilibrium in the kidneys, which may be an additional factor.

 

Why do I feel the need to post this article today?

Another of those wonderful athletes and sporting-class hero died recently, at a young age.

He had presented with the nephrotic syndrome a few years ago and was a chronic hemodialysis patient since then.

Of course, I know nothing of his case in detail. Yet, one cannot help but feel uneasy, again. 

 

So, yes, doping is a cheat and is unethical. This not my point today.


 

But the physicians active in the world of top-sport who deliver such products,

or silently witness their administration, are criminals.

They cannot claim they don't know, the evidence is clear to see for a specialist.

They are guilty in the first place and should be severely punished,

as well as banned forever.

 

 

* Ref: Development of Focal Segmental Glomerulosclerosis after Anabolic Steroid Abuse

 

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