Table 1.

Summary of experimental and clinical studies about the renal safety of anabolic-androgenic steroids (n = 12)

Dose & Duration	Subjects	Type of study	Main results	Reference
50 mg/day dihydrotestosterone intraperitoneally for 10 days	Rats	Experimental	- Increase in blood pressure, and proximal tubule volume reabsorption - Decrease in serum angiotensin II level - No change in glomerular filtration rate	Quan et al. 2004 [29]
500 μg/kg/day testosterone propionate intramuscularly for 2 weeks	Castrated male and oophorectomized female rats with obstructive renal injury	Experimental	Increase in TNF-α production and pro-apoptotic and pro-fibrotic signaling leading to increased apoptotic cell death, tubulointerstitial fibrosis, and renal dysfunction	Metcalfeet al 2008 [28]
0.75 or 2.0 mg/day dihydrotestosterone as subcutaneous implants for 14 weeks	Castrated diabetic male rats	Experimental	- Low doses attenuated castration-associated increases in urine albumin excretion, glomerulosclerosis, and tubulointerstitial fibrosis - High doses exacerbated castration-associated increases in urine albumin excretion, glomerulosclerosis, and tubulointerstitial fibrosis	Xu et al. 2009 [56]
Testosterone implants (20 mg/capsule) changed every 2 weeks	Hypertensive rats on a high sodium diet	Experimental	- Increase in blood pressure & renal sodium reabsorption - Increase in glomerulosclerosis	Liu&Ely 2011 [33]
Single dose of testosterone (12.5 mg/pellet) orally	Female estrogen receptor knockout mice	Experimental	Inducing podocyte apoptosis by androgen receptor activation, independent of the TGF-β1 signaling pathway	Doublier et al. 2011 [48]
Combination of 0.75 mg/day dihydrotestosterone as subcutaneous implants and 0.15 mg/kg/day anastrozole orally for 12 weeks	Diabetic male rats	Experimental	- Attenuating albuminuria, glomerulosclerosis, and tubulointerstitial fibrosis - Decrease in the density of renal cortical CD68-positive cells - Decrease in the expression of transforming growth factor-β, collagen type IV, TNF-α, and IL-6	Manigrasso et al. 2012 [55]
Case 1: Not defined	Case 1: 21-year-old male athlete	Case report and case series	- Arterial hypertension, oliguria, leukocyturia, hematuria and proteinuria, increase in serum urea and creatinine - Moderate interstitial inflammatory infiltrate with eosinophils, interstitial edema, calcium deposits, and mild acute tubular necrosis	Daher et al. 2009 [20]
Case 2: Not defined	Case 2: 30-year-old male bricklayer		- Increase in serum urea and creatinine, hematuria and proteinuria - Mild interstitial lymphmononuclear inflammatory infiltrate with eosinophils without remarkable tubular abnormalities
Case series: Not defined	Case series: Males & Females aged between 21 and 63 years		- Interstitial nephritis and hypercalcemia secondary to vitamin D intoxication caused acute kidney injury
At least one anabolic steroid (e.g., testosterone 500 mg twice weekly) intramuscularly for several months	10 body builders aged between 28 and 49 years	Case series	- Proteinuria, renal insufficiency, and nephrotic syndrome - Focal segmental glomerulosclerosis, tubular atrophy, and interstitial fibrosis	Herlitz et al. 2010 [57]
Not defined	38-year-old man	Case report	- High serum creatinine, high serum urea, low hemoglobin level - Intrinsic renal parenchymal and focal segmental glomerulosclerosis	Harrington et al. 2011 [58]
- Nandrolone intramuscular injection 400 mg twice per week for 6 weeks - Testosterone intramuscular injection 400 mg once per week for 6 weeks	41-year-old male bodybuilder	Case report	Acute kidney injury with the pathology of diffuse acute tubular injury due to bile acid nephropathy with the pathology of tubular bile acid casts	Luciano et al. 2014 [19]
Case 1: Stanozolol intramuscular injection 10 mg three times per week for 5 weeks Case 2: Stanozolol intramuscular injection 1 mg three times per week for 6 weeks	Case 1: 30-year-old male amateur bodybuilder Case 2: 43-year-old male amateur bodybuilder	Case report	Bile cast nephropathy due to cholestatic jaundice characterized by acute tubular epithelial cell damage along with increased serum creatinine and oliguria	Tabatabaee et al. 2015 [23]
Oxandrolone, boldenone undecyclenate, stanozolol, and trenabol (with not-defined daily dose and duration of treatment)	28-year-old male bodybuilder	Case report	Acute kidney injury in the setting of severe cholestatic jaundice with the pathology of bile inclusions within tubular cells and interstitial edema	Alkhunaizi et al. 2016 [24]