Flex and Kidney failure

[bodybuildermdpitt]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

[Darth Muscle]

Yeah me too.......

[affy]

im brad pitt

really i am

[Pollux]

im brad pitt

really i am

And I'm Arnold Schwarzenegger. Please do not bombard me with PM's. 

[RadOncDoc]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Since you're a doctor, you should probably recognize that hypertensive emergencies are defined by the presence of end-organ damage. Significantly elevated BP without end-organ damage constitutes hypertensive urgency.    And, yes, I agree with others--this post sounds a little fishy. It doesn't read like it has been written by a true health care professional. And even if this guy really is a GI surgeon (which I seriously doubt), he would not be in any position to make authoritative statements on a renal topic. You learn very little about glomerulonephropathies in medical school or in any of the training that would be required to become a GI surgeon.

[Joey Tito]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

best gimmick ever

[ARMZ]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Hi Flex

[Matt C]

Flex's kidney failure had nothing to do with anabolic steroid use.

True, other than the damage anabolic steroids did to Flex's kidneys due to increases in blood pressure.  Diuretics and possible recreational drug abuse more than likely contributed the most.  If Flex did have a genetic condition and continued to compete, that makes him more irresponsible, not less.

Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium.

Epic rationalizing monster drug abuse.  LOW DOSES of testosterone may be good, as it is good for a lot of things, but ABUSE of testosterone is not.

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Hi Flex.

[bodybuildermdpitt]

Since you're a doctor, you should probably recognize that hypertensive emergencies are defined by the presence of end-organ damage. Significantly elevated BP without end-organ damage constitutes hypertensive urgency.    And, yes, I agree with others--this post sounds a little fishy. It doesn't read like it has been written by a true health care professional. And even if this guy really is a GI surgeon (which I seriously doubt), he would not be in any position to make authoritative statements on a renal topic. You learn very little about glomerulonephropathies in medical school or in any of the training that would be required to become a GI surgeon.

I am not trying to give any medical advice. However, my Radoncdoc buddy, when I did rotate through transplant, we always taught to view any transplanted organ as a failing organ, hence the use "emergency" and not "urgency." I don't know what year you took your steps, I took them in the early 90s, nephrology was a pretty heavily tested topic. By the way, I really feel for you guys if the Dems come to power. 33% projected decrease in compensation for radiation oncologists.

cheers,

bodybuildermdpitt
 

[Matt C]

I am not trying to give any medical advice. However, my Radoncdoc buddy, when I did rotate through transplant, we always taught to view any transplanted organ as a failing organ, hence the use "emergency" and not "urgency." I don't know what year you took your steps, I took them in the early 90s, nephrology was a pretty heavily tested topic. By the way, I really feel for you guys if the Dems come to power. 33% projected decrease in compensation for radiation oncologists.

cheers,

bodybuildermdpitt
 

Democratic economic policy = not having a clue.

Michael Moore: "Get the profit motive out of medicine."

Modern medicine wouldn't be where it is today without the profit motive.    Hope this helps.

[Darth Muscle]

I am not trying to give any medical advice. However, my Radoncdoc buddy, when I did rotate through transplant, we always taught to view any transplanted organ as a failing organ, hence the use "emergency" and not "urgency." I don't know what year you took your steps, I took them in the early 90s, nephrology was a pretty heavily tested topic. By the way, I really feel for you guys if the Dems come to power. 33% projected decrease in compensation for radiation oncologists.

cheers,

bodybuildermdpitt
 

Are you familiar with the damage caused by abuse, not use, abuse of oral steroids and diuretics on the kidneys and liver?  How would/could that factor in this case or Don Long's or Tom Prince's?  The only constant other than they are all bodybuilders is Chad Nichols.

[Matt C]

Are you familiar with the damage caused by abuse, not use, abuse of oral steroids and diuretics on the kidneys and liver?  How would/could that factor in this case or Don Long's or Tom Prince's?  The only constant other than they are all bodybuilders is Chad Nichols.

Mercury based diuretics.

[bodybuildermdpitt]

True, other than the damage anabolic steroids did to Flex's kidneys due to increases in blood pressure.  Diuretics and possible recreational drug abuse more than likely contributed the most.  If Flex did have a genetic condition and continued to compete, that makes him more irresponsible, not less.

Epic rationalizing monster drug abuse.  LOW DOSES of testosterone may be good, as it is good for a lot of things, but ABUSE of testosterone is not.

Hi Flex.

True, other than the damage anabolic steroids did to Flex's kidneys due to increases in blood pressure.  Diuretics and possible recreational drug abuse more than likely contributed the most.  If Flex did have a genetic condition and continued to compete, that makes him more irresponsible, not less.

Epic rationalizing monster drug abuse.  LOW DOSES of testosterone may be good, as it is good for a lot of things, but ABUSE of testosterone is not.

Hi Flex.

I agree with everything you are saying, I am not rationalizing or advocating anabolic steroid use. However, if you do look at the new literature coming out, especially when dealing with end stage renal disease patients, HIGH dose anabolic steroids is actually showing some renal protective effects. However, you are correct in stating that high levels of testosterone does cause hypertension and more importantly, in Flex's case, it can cause an increase in artherosclerosis (although this is still a grey zone topic, since I have yet to see a conclusive study proving this). Which along with his hypercoaguable state, due to his nephrotic disease, he could have a superimposed secondary hypertension due to unoppossed renin secretion. Good luck in trying to find a urologist or vascular surgeon for that matter who will stent a transplanted kidney.

cheers,

bodybuildermdpitt

[Cee21Jay]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Do you think drug use or diuretics could have hastened his misfortune? 

I briefly checked emedicine  http://www.emedicine.com/med/topic2944.htm and it states

"Causes: FSGS is considered primary or idiopathic when no etiology can be identified. Secondary FSGS is associated with illicit drug use, HIV and other viral infections, and many diverse factors, such as infections, inflammations, toxins, and intrarenal hemodynamic alterations".

Maybe a person could acquire this from an infection from needle or synthol etc.  Maybe something like DNP could have triggered a predispostion or actually caused this?  Maybe aromatized estrogenic hormones perform the reverse function that testosterone appears to do (as you stated a possible helpful effect of testosterone).  I am not convinced that drug use could not damage the kidneys in such a way or hasten a predispostion.  Drugs can certainly be seen as toxins. 

I would not trust your opinion unless you were a board certified nephrologist j/k.

[bodybuildermdpitt]

Mercury based diuretics.

Not to step on anybody toes, but that is not the complete story with Tom Prince. I am not familiar with Don Long's case, so I can not comment on that. Tom Prince's problems actually occured from chronic anelgesic use. From what I hear, he took anelgesics like candy. Taking anelgesics is going to cause renal papillary necrosis and tubulointerstitial nephritis. I believe this is what caused his kidneys to fail. This is only my theory, the only one that really knows is his doctor.

cheers,

bodybuildermdpitt

[The Squadfather]

I am not trying to give any medical advice. However, my Radoncdoc buddy, when I did rotate through transplant, we always taught to view any transplanted organ as a failing organ, hence the use "emergency" and not "urgency." I don't know what year you took your steps, I took them in the early 90s, nephrology was a pretty heavily tested topic. By the way, I really feel for you guys if the Dems come to power. 33% projected decrease in compensation for radiation oncologists.

cheers,

bodybuildermdpitt
 

are you the guy who goes by Pittdoc or something like that on Mayhem?

[gordiano]

Hi Flex

Shit, you beat me to it.....

[bodybuildermdpitt]

Hey Doc, how would multiple bottles of Nubain every week, along with those analgesics factor into Prince's misfortune?

Nubain is a narcotic. The risk for addiction and sedation are going to be a much bigger concern than your renal functions. In terms of physiologic effects, I am not quite sure. I am also not sure how somebody could train that intensely with all the sedation that Nubain causes. Prince really played the size game and I am sure he was pushing up massive numbers. I would be much more concerned about having a seizure or feeling sedated with 500 pounds above me than my renal function.

cheers,

bodybuildermdpitt

[phyxsius]

I'm John McClain. I'll never die

[Brutal_1]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

1. You might be a doc, but do you lift?  You understand that for Flex to compete again he actually has to lift weights right?  How in the world can someone lift weights with keeping their bp that low?!  Even moderate leg or back lifts would take it beyond that...

2. Again, if you're really a doc....got residency hook ups??? 

[youandme]

Nubain is a narcotic. The risk for addiction and sedation are going to be a much bigger concern than your renal functions. In terms of physiologic effects, I am not quite sure. I am also not sure how somebody could train that intensely with all the sedation that Nubain causes. Prince really played the size game and I am sure he was pushing up massive numbers. I would be much more concerned about having a seizure or feeling sedated with 500 pounds above me than my renal function.

cheers,

bodybuildermdpitt

Oh believe you in me, you can train hard as hell while on bain.

Hey doc take a look at the Bethany Carter Howlett thread, is that a transgender?

[bodybuildermdpitt]

1. You might be a doc, but do you lift?  You understand that for Flex to compete again he actually has to lift weights right?  How in the world can someone lift weights with keeping their bp that low?!  Even moderate leg or back lifts would take it beyond that...

2. Again, if you're really a doc....got residency hook ups??? 

I think you are confusing acute changes in BP with causing renal failure. When one lifts weights, your blood pressure is acutely raised, it is not raised throughout the day. If BP stayed at the level during weight lifting, every single one of us would have renal failure. There are defintely some acute pathologies that may occur, in Flex's case, he may be at high risk for stroke, especially if he has underlying nephrotic disease which intrinsically causes a hypercoaguble state. However, going back to your question, he should be able to keep his BP low, if he has a good physician overseeing his care. Sadly, he will most likely go to a "Guru," who may know a lot about anabolic steroids, but have no idea about patient care.

cheers,

bodybuildermdpitt

ps. I am done posting for the night, there is a case about to come in...

[bigdumbbell]

a case of budwiser?

[RagingBull]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Can you please tell us who first nicknamed you 'Flex'?

[RadOncDoc]

Hello everybody,

I have been reading this forum for a while, usually for laughter on night call. However, I want to clear up a knowledge gap in this forum. Flex's kidney failure had nothing to do with anabolic steroid use. The poor guy actually suffered from Focal Segmental Glomerulosclerosis. This disease is actually quite common in the African American population; interestingly enough it is also common in HIV patients and IV drug users. This is a nephrotic disease that causes sclerosis of the glomerulor tuft. Interestingly enough, the latest literature is actually showing some renal protective effects of testosterone, especially of the tubular epithelium. The pathophysiology behind that is actually quite interesting, but that is another topic by itself. Going back to Flex, if he wants to compete, he proabably could without any long term effects. He should have his BUN/Cr measured religiously, and more imporatantly he should have his BP under control. At least below 135/75, to prevent end organ damage of his remaining kidney. This is going to be his biggest concern, since if he is still on immunosuppressants, epecially if he is on either tacrolimus or cyclosporin (both of which can cause BP emergencies : which is bascially a BP over 200/110). I wish Flex the best, and I hope this post clears up any misinformation. I will try to answer any questions if you guys have any. Unfortunately I am on call tonight.

cheers,

bodybuildermdpitt

and yes I am a doctor, actually a board certified GI surgeon to be exact 

Okay, I have some questions.

1. High protein diets seem to be the norm in bodybuilding circles. Presumably Flex has been advised to maintain a protein-restricted diet. Can he "safely" resume a bodybuilding diet.

2. This is completely unrelated to the original topic, but since we're both healtcare practitioners, I'll bring it up anyway: hypertensive emergency implies acute end-organ damage requiring immediate IV anit-hypertensive therapy. You seem to be implying that any BP elevation in someone with chronic renal failure implies hypertensive emergency. I don't think this is the case. If a person with chronic renal failure has an acute exacerbation on top of chronic renal failure and this exacerbation is due to significantly elevated BP, then that would constitute a hypertensive emergency. However, a mildly elevated BP in someone with CRF is not a hypertensive emergency. Do we treat all mildely hypertensive CRFers with IV labetolol?