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Revisiting glomerular hyperfiltration and examining the concept of high dietary protein-related nephropathy in athletes and bodybuilders

Authors
Cho, EunjungChoi, Soo JeongKang, Duk-HeeKalantar-Zadeh, KamyarKo, Gang-Jee
Issue Date
Jan-2022
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
anabolic steroid nephropathy; glomerular hyperfiltration; high protein-induced nephropathy; kidney health
Citation
Current Opinion in Nephrology and Hypertension, v.31, no.1, pp.18 - 25
Indexed
SCIE
SCOPUS
Journal Title
Current Opinion in Nephrology and Hypertension
Volume
31
Number
1
Start Page
18
End Page
25
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/55401
DOI
10.1097/MNH.0000000000000755
ISSN
1062-4821
Abstract
Purpose of review High-protein diets (HPDs) are popular but their consequences for kidney health, especially among athletes and bodybuilders who typically maintain a high protein intake for a long time, have not been investigated. This review focused on recent studies of the association of HPD with long-term kidney health and the concept of high dietary protein-related nephropathy. Recent findings Several long-term observational studies including large populations have reinforced the notion that HPDs are associated with a rapid decline of kidney function. An increase in renal blood flow and glomerular hyperfiltration caused by vasodilation, and increased levels of endocrine and paracrine factors (glucagon, IGF-1, prostanoids, and nitric oxide), facilitates the excretion of protein-derived nitrogenous waste. Inhibition of tubule-glomerular feedback and increased proximal tubular Na+ reabsorption after a HPD augment glomerular hyperfiltration and may trigger synthesis of proinflammatory cytokines and receptor for advanced glycation end-products (RAGE). Focal segmental glomerulosclerosis reported in association with anabolic steroid may indeed be a HPD nephropathy given that HPD results in progressive glomerulosclerosis, especially in remnant glomeruli or in diabetic kidney disease but can happen in any high-risk situation, such as solitary kidney and polycystic kidneys. Summary HPD among athletes and bodybuilders in an extreme way across a long-term period may pose a risk to renal health including high incidence of HPD nephropathy.
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Cho, Eun Jung
Guro Hospital (Department of Nephrology and Hypertension, Guro Hospital)
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