Chronic Nephropathies of Cocaine and Heroin Abuse

Abstract

Renal disease in cocaine and heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis, and rhabdomyolysis. The pathophysiologic basis of cocaine-related renal injury involves renal hemodynamic changes, glomerular matrix synthesis and degradation, and oxidative stress and induction of renal atherogenesis. Heroin is the most commonly abused opiate in the United States. Previous studies identified a spectrum of renal diseases in heroin users. The predominant renal lesion in black heroin users is focal segmental glomerulosclerosis and in white heroin users is membranoproliferative glomerulonephritis. Although the prevalence of heroin use in the United States has increased, the incidence of "heroin nephropathy" has declined. Because reports of heroin nephropathy predated the surveillance of hepatitis C virus and HIV, the varied findings might be related to the spectrum of viral illnesses that are encountered in injection drug users. Socioeconomic conditions, cultural and behavioral practices, or differences in genetic susceptibilities may be more associated with the development of nephropathy in heroin users than the drug's pharmacologic properties. Administration of cocaine in animal models results in nonspecific glomerular, interstitial, and tubular cell lesions, but there is no animal model of heroin-associated renal disease. The heterogeneity of responses that are associated with heroin is not consistent with a single or simple notion of nephropathogenesis. There are no well-designed, prospective, epidemiologic studies to assess the incidence and the prevalence of renal disease in populations of opiate users and to establish the validity of a syndrome such as heroin nephropathy. It is concluded although there is a paucity of evidence to support a heroinassociated nephropathy, the evidence from in vitro cellular and animal studies to support the existence of cocaine-induced renal changes is more convincing.

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

“…Nephrotoxic effects of cocaine are numerous and thought to be related to changes in renal hemodynamics and glomerular matrix synthesis, degradation and oxidative stress, and induction of renal atherogenesis (66,67). Cocaine is one of many abused drugs that can cause rhabdomyolysis, and this is probably the most common reason for AKI associated with cocaine use (68,69).…”

“…Cocaine is one of many abused drugs that can cause rhabdomyolysis, and this is probably the most common reason for AKI associated with cocaine use (68,69). With regard to altering renal hemodynamics, it is known that cocaine causes vascular smooth muscle constriction and inhibits reuptake of serotonin, norepinephrine, and dopamine to promote hypertension and tachycardia (66). Reports implicate this may be due in part to increased production of endothelin-1, which acts on its cognate receptors located on vascular smooth muscle cells of renal resistance vessels to decrease renal blood flow and GFR (70)(71)(72).…”

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

“…[25] However, it is unlikely that intravenous drug use was relevant in this group of patients; no such drug use was reported, and no patient was hepatitis B-or C-positive. Only one patient was found to be HIVpositive.…”

Depression and Anxiety in Urban Hemodialysis Patients

“…The rate of anxiety disorders (27%) was somewhat higher than the expected rate (18%) on the basis of the National Comorbidity Survey (45). The rates of substance abuse disorders and psychotic disorders were higher than community averages, but that was anticipated because of the relationship between the cause of kidney disease and substance abuse (6,46,47) and the known prevalence of psychiatric disorders in patients who have ESRD and are treated with hemodialysis (6,48).…”