Does gymnasium harbor an endemic cause of end stage kidney disease? a case report & review of literature

Gymnasium is the Latin word for old Greek word gymnasion which means a place where young men practice physical & intellectual activities. It is a place of intellectual activities which can be found in European languages. In contrary, Gymnasium in English language is defined as being a place for physical activities only and shortened to the form “Gym”. Nowadays, in Gym, athelets beside the practice of physical activity, they frequently consume non hormonal and hormonal supplements in order to acquire a muscle bulk and strength in a short time.1 The main non-hormonal supplements include proteins, creatine and vitamins, and the hormonal supplements are the anabolic steroids.2 Recently reported in literature that 10 body builders suffered chronic kidney disease due to focal segmental glomerulosclerosis (FSGS) after consuming large amounts of anabolic steroids with high protein daily intake of 300–550 g/day.3 The high-protein intake carries a lot of concern because it increases glomerular filtration rates and proved experimentally to be associated with glomerular hyper filtration ending with FSGS.2 Furthermore, pure creatine powder is marketed as a muscle building supplement. It is safe & effectively contributing to exercise tolerance and improve muscle strength.4,5 Creatine is widely used by casual and professional athletes.6 The reported adverse events is usually because of the exercise-induced rhabdomyolysis and dehydration leading to acute kidney injury.7 However, many cases report un-linking creatine-associated acute kidney injury to rhabdomyolysis.8–11 A one report describing a body builder suffered from acute tubular necrosis after taking a high dose up to 20 g/day for a week.9 Another report, describing acute intestinal nephritis in two body builders.10,11