Bile Cast Nephropathy Because of Acute Liver Injury Associated With Selective Androgen Receptor Modulators

Chinnawat Arayangkool; Maan Gozun; Manasawee Tanariyakul; Witina Techasatian; Thiratest Leesutipornchai; Yoshito Nishimura

doi:10.14309/crj.0000000000001105

Bile Cast Nephropathy Because of Acute Liver Injury Associated With Selective Androgen Receptor Modulators

ACG Case Rep J. 2023 Jul 26;10(7):e01105. doi: 10.14309/crj.0000000000001105. eCollection 2023 Jul.

Authors

Chinnawat Arayangkool¹, Maan Gozun¹, Manasawee Tanariyakul¹, Witina Techasatian¹, Thiratest Leesutipornchai¹, Yoshito Nishimura¹

Affiliation

¹ Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.

Abstract

Selective androgen receptor modulators (SARMs) are novel nonsteroidal agents abused for performance enhancement such as anabolic steroids. We report a case of a 27-year-old man who used 3 different SARMs and presented with progressive weakness. Initial laboratory testing showed kidney and liver injury with creatinine 4.8 mg/dL and total bilirubin 43.3 mg/dL. An extensive workup was negative for other causes, and the results of liver and kidney biopsies were consistent with bile cast nephropathy because of SARM-associated drug-induced liver injury. His organ functions improved with the cessation of SARMs and plasmapheresis. Providers need to recognize the extreme consequences of SARM use.

Keywords: bile cast nephropathy; drug-induced liver injury; selective androgen receptor modulator.

Publication types

Case Reports