How can corticosteroids induce Acute Kidney Injury (AKI)?

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Last updated: May 4, 2025 • View editorial policy

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From the Guidelines

Steroids can engender acute kidney injury through various mechanisms, including direct damage to kidney tissues, rhabdomyolysis, and induction of hypertension, diabetes, and electrolyte imbalances, as supported by recent studies 1.

Mechanisms of Steroid-Induced Acute Kidney Injury

The use of steroids, particularly anabolic steroids and corticosteroids, has been associated with an increased risk of acute kidney injury (AKI) due to several mechanisms:

  • Direct damage to kidney tissues through increased oxidative stress and inflammation
  • Rhabdomyolysis, where damaged muscle releases proteins that overwhelm and injure the kidneys
  • Induction of hypertension, diabetes, and electrolyte imbalances, which can worsen kidney function
  • Promotion of kidney stone formation, which may obstruct urine flow and lead to AKI
  • Alteration of immune function and damage to the kidney's filtering units, leading to glomerular disease

Recommendations for Patients Using Steroids

To minimize the risk of steroid-induced AKI, patients should:

  • Maintain adequate hydration
  • Monitor blood pressure and blood sugar regularly
  • Undergo periodic kidney function tests
  • Use the lowest effective dose for the shortest necessary duration
  • Exercise extreme caution when using steroids, especially in patients with pre-existing kidney disease, hypertension, or diabetes, as recommended by recent guidelines 1.

Management of Immune-Related Adverse Events

In patients treated with immune checkpoint inhibitor therapy, the management of immune-related adverse events, including AKI, is crucial to prevent long-term kidney damage. According to recent guidelines 1, patients should have their renal function checked prior to every dose of checkpoint inhibitor therapy, and those with new elevations in creatinine should be evaluated for other potential causes and treated empirically if necessary.

From the FDA Drug Label

Cardio-Renal As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency. The FDA drug label does not answer the question.

From the Research

Mechanisms of Acute Kidney Injury

  • Direct renal toxicity: Steroids, such as androgenic-anabolic steroids (AAS), can cause direct damage to the kidneys, leading to acute kidney injury (AKI) 2.
  • Glomerular hyperfiltration: The use of AAS and other substances can lead to glomerular hyperfiltration, which can cause damage to the kidneys and increase the risk of AKI 2.
  • Hypercalcemia: The use of certain substances, such as vitamin supplements, can lead to hypercalcemia, which can cause kidney damage and increase the risk of AKI 2.

Risk Factors for Acute Kidney Injury

  • Use of androgenic-anabolic steroids (AAS) and other performance-enhancing substances: The use of these substances can increase the risk of AKI due to their potential to cause direct renal toxicity, glomerular hyperfiltration, and hypercalcemia 2.
  • Infections and hypovolaemic shock: These conditions can cause AKI, especially in low-income and middle-income countries 3.
  • Sepsis, drugs, and invasive procedures: These factors can cause AKI, especially in elderly patients in high-income countries 3.

Pathophysiology of Acute Kidney Injury

  • Acute tubular necrosis: This is a common cause of AKI, and can be caused by either ischemia or nephrotoxicity 4.
  • Inflammation and fibrosis: AKI can lead to inflammation and fibrosis in the kidneys, which can cause long-term damage and increase the risk of chronic kidney disease (CKD) 3, 4.

Treatment and Management of Acute Kidney Injury

  • Corticosteroids: These may be used to treat AKI, especially in cases of acute interstitial nephritis, but their effectiveness and optimal duration of treatment are still being studied 5, 6.
  • Fluid and electrolyte management: These are essential in the management of AKI, and can help to prevent further kidney damage and improve outcomes 3.
  • Kidney replacement therapy: This may be required in severe cases of AKI, and can help to support the kidneys and improve outcomes 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Acute kidney injury.

Nature reviews. Disease primers, 2021

4
Research

Acute Kidney Injury: Medical Causes and Pathogenesis.

Journal of clinical medicine, 2023

5
Research

Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis.

Clinical journal of the American Society of Nephrology : CJASN, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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