Can elastography visualize kidney damage in bodybuilders with high protein intake?

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Umut Kantarcı
Zekine Punduk
Omer Senarslan


Elastography; Kidney; Protein; Renal; Stiffness



Introduction: High muscle mass and protein consumption may lead to a rise in serum creatinine levels. Therefore, increased serum creatinine levels do not always imply kidney dysfunction. Elastography was proposed for detection of renal impairment. We investigated the correlation between kidney stiffness and kidney damage in bodybuilders who are on high-protein diet. Materials and Methods: Bodybuilders who were on high-protein diet were compared with control subjects. Blood urea nitrogen/creatinine ratios and estimated glomerular filtration rates (eGFR) were calculated. Bodybuilders were divided into two subgroups as per eGFR levels (Group A and B for eGFR below or above 90; respectively). Length, width, volume, cortical thickness, and echogenicity of both kidneys were analyzed by ultrasound. Elastographic Shear Wave Velocity (SWV) measurements were performed, and mean SWV values (m/s) were calculated for each kidney. Comparison of mean SWV values was performed between the groups and subgroups. Results: Nineteen bodybuilders and 20 healthy control subjects were included. Mean BUN and serum Cr levels were higher in bodybuilders than control subjects (p<0,05). Cortical thicknesses and echogenicity were both higher in bodybuilders (p<0,05). The SWV values were higher in bodybuilders than control group indicating increased stiffness (p<0,05). Among bodybuilders, SWV values were significantly higher in group A than in group B (p<0,001). Conclusions: Elastography can be utilized for detection and follow-up of alterations in kidneys of bodybuilders or patients consuming high protein diets. High SWV can be considered as an indicator of renal damage, while the levels of conventional biomarkers may give confusing results.


Elastography; Kidney; Protein; Renal; Stiffness


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1. Asano K, Ogata A, Tanaka K, et al. Acoustic radiation force impulse elastography of the kidneys: Is shear wave velocity affected by tissue fibrosis or renal blood flow? J Ultrasound Med. 2014; 33:793-801.
2. Peride I, Rădulescu D, Niculae A, Ene V, Bratu OG, Checheriță IA. Value of ultrasound elastography in the diagnosis of native kidney fibrosis. Med Ultrason. 2016; 18:362-9.
3. Guo LH, Xu HX, Fu HJ, Peng A, Zhang YF, Liu LN. Acoustic radiation force impulse imaging for non-invasive evaluation of renal parenchyma elasticity:Preliminary findings. Plos One. 2013; 8(7): e68925. doi: 10.1371/journal. pone.0068925.
4. Sarvazyan A, Hall TJ, Urban MW, Fatemi M, Aglyamov SR, Garra BS. An overview of elastography- an emerging branch of medical imaging. Curr Med Imaging Med. 2011; 7:255-82.
5. Wu G. Dietary protein intake and human health. Food Funct. 2016; 7:1251-65.
6. Friedman AN. High-protein diets: Potential effects on the kidney in renal health and disease. Am J Kidney Dis. 2004; 44:950-62.
7. Spendlove J, Mitchell L, Gifford J, et al. Dietary intake of competitive bodybuilders. Sports Med. 2015; 45:1041-63.
8. Sandilands EA, Dhaun N, Dear JW, Webb DJ. Measurement of renal function in patients with chronic kidney disease. Br J Clin Pharmacol. 2013; 76:504-15.
9. Gounden V, Jialal I. Renal Function Tests. Treasure Island (FL): StatPearls Publishing; 2020-. 2019 Apr 3.
10. Kindgen-Milles D, Slowinski T, Dimski T. New kidney function tests: Renal functional reserve and furosemide stress test. Med Klin Intensivmed Notfmed. 2020; 115:37-42.

11. Grenier N, Gennisson JL, Cornelis F, Le Bras Y, Couzi L. Renal ultrasound elastography. Diagn Interv Imaging. 2013; 94: 545-50.
12. Navarro VJ, Khan I, Björnsson E, Seeff LB, Serrano J4, Hoofnagle JH. Liver injury from herbal and dietary supplements. Hepatology. 2017; 65: 363-373.
13. Wong CP, Bray TM, Khanna SK. Growth, Bone Health and Cognition: Nutritional Evaluation of a Sustainable Ocean-Based Advance Protein Powder. Ecol Food Nutr. 2019; 58: 80-92.
14. Kramer H. Diet and Chronic Kidney Disease. Adv Nutr. 2019; 10: S367-S379.
15. Yue H, Zhou P, Xu Z, et al. Effect of low-protein diet on kidney function and nutrition in nephropathy: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2019; pii: S0261-5614(19)33166-8. Doi: 10.1016/j.clnu.2019.11.039.
16. Singh A, Zapata RC, Pezeshki A, Knight CG, Tuor UI, Chelikani PK. Whey Protein and Its Components Lactalbumin and Lactoferrin Affect Energy Balance and Protect against Stroke Onset and Renal Damage in Salt-Loaded, High-Fat Fed Male Spontaneously Hypertensive Stroke-Prone Rats. J Nutr. 2019; pii: nxz312. Doi: 10.1093/jn/nxz312.
17. Schwingshackl L, Hoffmann G. Comparison of high vs. normal/low protein diets on renal function in subjects without chronic kidney disease: a systematic review and meta-analysis. Plos One. 2014; 9: e97656. Doi: 10.1371/journal.pone.0097656.
18. Kalyoncu Ucar A, Cicek RY, et al. Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux. J Ultrasound Med. 2019; 38: 379-85.

19. Chiocchini ALC, Sportoletti C, Comai G, et al. Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear Wave Elastography in Patients with Kidney Transplantation. Prog Transplant. 2017; 27:346-53.
20. Cai Y, Li F, Li Z, Du L, Wu R. Diagnostic Performance of Ultrasound Shear Wave Elastography in Solid Small (≤4 cm) Renal Parenchymal Masses. Ultrasound Med Biol. 2019; 45: 2328-37.
21. Hansen KL, Nielsen MB, Ewertsen C. Ultrasonography of the Kidney: A Pictorial Review. Diagnostics (Basel). 2015; 6: pii: E2. Doi: 10.3390/diagnostics6010002.
22. Bruno C, Minniti S, Bucci A, Pozzi Mucelli R. ARFI: from basic principles to clinical applications in diffuse chronic disease—a review. Insights Imaging. 2016; 7:735–46.
23. Aparicio VA, Nebot E, Porres JM, et al. Effects of high-whey-protein intake and resistance training on renal, bone and metabolic parameters in rats. Br J Nutr. 2011; 105:836-45.
24. Jia Y, Hwang SY, House JD, Ogborn MR, Weiler HA, O K, Aukema HM. Long-term high intake of whole proteins results in renal damage in pigs. J Nutr. 2010; 140: 1646-52.
25. Pearle MS. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Int Braz J Urol. 2002; 28: 571-2.
26. Yoshizumi WM, Tsourounis C. J Herb Pharmacother. Effects of creatine supplementation on renal function. 2004; 4:1-7.
27. Kamianowska M, Szczepański M, Wasilewska A. Tubular and Glomerular Biomarkers of Acute Kidney Injury in Newborns. Curr Drug Metab. 2019; 20: 332-49.
28. Kahal A, Allem R. Reversible effects of anabolic steroid abuse on cyto-architectures of the heart, kidneys and testis in adult male mice. Biomed Pharmacother. 2018; 106: 917-22.