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A 16-year-old boy presented with history of vomiting and headache of 15 days
duration. On evaluation, he was found to have blood pressure of 160/80 mmHg. He
had a history of consumption of anabolic steroids (dexona +
Dianabol [methandrostenolone] combination) for general body development for
a duration of 3 months.
Laboratory studies revealed a serum creatinine of 2.27 mg/dl, urine protein to
creatinine ratio of 6, proteinuria of 4.7 g in 24 h. Urine microscopy showed
10-12 white blood cells and 5-40 red blood cells per high power field. His liver
function tests (LFT) were normal. There was no jaundice or evidence of
cholestasis. Tests for antibodies to HIV, hepatitis B and C viruses were
negative. There was no biochemical evidence of a TMA. Ultrasound examination of
both kidneys revealed Grade II renal parenchymal changes.
The present case describes short-term anabolic steroid abuse and development of
CG in a young patient from a low risk population with underlying primary IgAN.
The diagnosis of primary IgAN was based on LM, IF and electron microscopy (EM)
studies. EM demonstrated presence of paramesangial electron-dense deposits with
GBM thinning and splitting, which are additional ultrastructural findings
supportive of a primary rather than secondary IgAN.
Normal LFT also made IgAN secondary to drug-induced hepatic dysfunction
unlikely. The onset of CG followed intake of anabolic steroids and despite high
prevalence of IgAN in this population, there is no previous documentation of
concurrent CG and IgAN from India. There was no biochemical or histological
evidence of thrombotic microangiopathy (TMA) or severe ischemic changes or other
viral infections to suggest possible etiologies of CG.
Although all patients with IgAN exposed to anabolic steroids do not develop CG,
the temporal sequence of events in our case, as described above, helps identify
anabolic steroids as a co-factor precipitating CG in this patient.
Matthai SM, Basu G, Varughese S, Pulimood AB, Veerasamy T, et al. Collapsing
glomerulopathy following anabolic steroid use in a 16-year-old boy with IgA
nephropathy. Indian J Nephrol. 2015;25(2):99-102.
http://www.indianjnephrol.org/artic...=25;issue=2;spage=99;epage=102;aulast=Matthai
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