engleski

Testosterone abuse as a source of preanalytical variation of parameters in 24-hour urine – a case report

BACKGROUND-AIM: Various drugs and dietary supplements may temporarily affect nephrons and change urine constitution. We present a case of an outpatient with pathological 24h-urine findings incompatible with his clinical condition. Subsequent investigation revealed the reversible effect of testosterone abuse on parameters measured in 24h-urine sample, in this patient. METHODS: A 41-year-old recreational male athlete was admitted to outpatient cardiology department due to hypertension and dizziness. Patient reported that he gained 30 kg in the past 5 months, regularly exercises and is on high-protein, low-carbohydrate and low-fat diet. Intake of other supplements was unknown at the time of the first 24h-urine collection. Routine biochemistry and quantitative urinalysis were performed on AU680 chemistry instrument (Beckman Coulter, USA). RESULTS: Laboratory results indicated severe proteinuria (0, 5 g), albuminuria (166 mg), highly elevated urea (2093 mmol), uric acid (20415 μmol), creatinine (71, 6 mmol) and electrolytes (sodium 409 mmol, potassium 254 mmol, chloride 479 mmol, calcium 13 mmol, phosphorus 139, 5 mmol and magnesium 23, 4 mmol) in 24h-urine sample. Patient also had extensive polyuria (5L/24h) and extremely high creatinine clearance (412 ml/min/1, 73m2). Serum creatinine, urea, uric acid and electrolytes were within reference ranges. Findings in a repeated 24h-urine, 10 days after, were identical. Since 24h-urine findings were incompatible with patient clinical condition, possible sources of preanalytical errors were investigated. During thorough examination of personal patient history, patient has admitted the illegal use of testosterone, which explained his urine findings. CONCLUSIONS: This case illustrates secondary changes in kidney function as a consequence of testosterone abuse. Understanding the effects of supplement intake is important for proper interpretation of laboratory results.

preanalytical phase, patient preparation, testosterone, kidney

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