A 49-year-old competitive bodybuilder spent three straight days doing a high-repetition weighted abdominal crunch program. On the third day, he felt a pop and mild pain in his left side. He kept training. The next day, during a heavy incline bench press, the pain became severe enough to send him to the emergency department.
A CT scan showed a tear in his left kidney and a massive pool of blood, about 16.5 by 14.5 by 13.5 centimeters, that had collected behind his abdominal cavity. He had no known kidney disease and no history of trauma, but he reported regular anabolic steroid use. Doctors at Al-Amiri Hospital in Kuwait described the case in Urology Case Reports in a report published in September 2025.
A Warning Sign He Trained Through
According to the report, the bodybuilder did 300 weighted crunches with loads of up to 120 kilograms over three consecutive days. The authors reported that the incline press that set off the severe pain involved more than 300 kilograms.
On arrival, he had no fever, normal blood pressure, and no bruising or other signs of outside injury. His left abdomen, however, was swollen, rigid and guarded. His blood creatinine, a marker of kidney function, was elevated, though no earlier result was available for comparison.
The scan classified the damage as a grade III kidney laceration on a standard trauma scale, a deep tear that in his case ran through the lower part of the kidney.
A Bleed That Restarted Two Days Later
His hemoglobin dropped within hours, but a follow-up scan showed no active bleeding, so doctors chose bed rest, close monitoring, and pain control. His blood pressure, however, stayed high, around 160/100 mm Hg, and he was started on intravenous medication to lower it.
About two days later, his pain and abdominal swelling worsened, his blood pressure climbed above 200, and his hemoglobin fell sharply. A new scan showed the blood collection had grown and the lower kidney was actively bleeding.
Interventional radiologists threaded a catheter from his groin into the kidney’s arteries and blocked the bleeding branch with several tiny metal coils, a procedure called angioembolization. Two days later, fluid built up in his lungs, and he spent a short stretch in intensive care before improving. He went home nine days after admission.
The blood collection kept pressing on his kidney, a pattern called a Page kidney that can drive blood pressure up, so he stayed on blood pressure medication. A month after the procedure, the collection had shrunk only slightly, and his kidney function was improving but still mildly impaired. He was cleared to return gradually to light lifting.
There is no agreed timeline for returning to sport after this kind of injury. The authors noted that surveys suggest patients with lower-grade kidney injuries, grades I through III, are typically allowed up and moving about two weeks afterward, while those with grade IV or V injuries resumed activity after three to six weeks. Because so few comparable cases exist, they wrote, a standard recovery plan could not be set.
Most Spontaneous Kidney Ruptures Have a Hidden Cause
Spontaneous kidney rupture, first described in 1856, usually points to an underlying problem. The authors cite estimates that 95% of cases stem from existing kidney disease. A 2002 meta-analysis of 165 cases in the Journal of Urology traced 61% to tumors and 17% to blood vessel disorders.
The authors found only two earlier reports linked to physical activity. In one, a 20-year-old man’s kidney burst during heavy lifting, and it turned out to be badly swollen with trapped urine. In the other, a woman’s rupture after exercise revealed kidney cancer. The Kuwaiti team reported no underlying kidney disease in this bodybuilder.
That absence is what makes the case stand out, and it is why the team turned to his training and drug use for an explanation.
Steroids, Strain and Blood Pressure Under Suspicion
The authors stressed that a definitive cause could not be established. They proposed that long-term anabolic steroid use, combined with the intense pressure inside the abdomen from heavy lifting and weighted crunches, may have contributed. They also suspected he might have had undiagnosed high blood pressure, given his persistently elevated readings in the hospital.
Steroid misuse carries well-documented risks. The National Institute on Drug Abuse warns that anabolic steroids can lead to early heart attacks, strokes, liver tumors and kidney failure, and it lists high blood pressure among their effects on the heart and blood vessels. A 2009 Columbia University study of 10 bodybuilders who used steroids for years found that all had developed protein leakage into the urine and severe reductions in kidney function, with biopsies showing scarring inside the kidneys.
Those findings describe gradual damage rather than sudden rupture, and the link between steroids and this tear remains a hypothesis. The report describes a single patient, relied on his own account of drug use, and lacked earlier kidney tests for comparison.
The broader lesson is about warning signs. A pop followed by pain in the side or back during exertion is not something to push through. Sudden, severe flank or abdominal pain, especially with swelling, dizziness, or blood in the urine, warrants emergency care. People who use anabolic steroids should tell their doctors, since the drugs can affect blood pressure and kidney health.
Key Questions Answered
What happened to the bodybuilder?
His left kidney tore during intense weight training, causing a large collection of blood behind the abdominal cavity.
Did he have kidney disease?
No underlying kidney disease was reported, which is unusual because most spontaneous kidney ruptures are tied to an existing kidney problem such as a tumor.
Did steroids cause the rupture?
That is not proven. The authors proposed that long-term anabolic steroid use, combined with extreme abdominal pressure from lifting, may have contributed.
How was he treated?
Doctors first managed him with bed rest and monitoring. When the bleeding restarted, doctors used angioembolization, placing tiny coils to block the bleeding artery.
What symptoms need urgent attention?
Sudden, severe flank, back, or abdominal pain during exertion needs emergency care, especially with swelling, dizziness, or blood in the urine.
Published by Medicaldaily.com
