Spectrum of acute kidney injury associated with cocaine use: report of three cases

Abstract

BackgroundThe consequences of cocaine use are multisystemic, such as, for instance, renal failure, hepatotoxicity and pulmonary toxicity, with renal alterations being the focus of the present study. The use of substances that modify the base composition of cocaine (or adulterants) aiming to potentiate its effects also has an impact on these manifestations. The present study aims to report three cases with different diagnosis of acute kidney injury related to cocaine use.Case presentationCase 01 - A 30-year-old female patient, who regularly used cocaine, started to have lower-limb edema, which showed a progressive and ascending evolution, affecting the face a few days later, associated with an isolated febrile episode and oligoanuria. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) was verified: reactive 1:80, with renal biopsy compatible with rapidly progressive glomerulonephritis (RPGN). Case 02 - A 34-year-old female patient, with difficult-to-control hypertension and a frequent user of cocaine, showed generalized sudden edema together with diffuse and progressive pruritus associated with oliguria, fever, nausea, and vomiting. Schistocyte screening was positive, with negative direct Coombs test, and negative serologies for hepatitis B, C and HIV, as well as negative anti-double-stranded DNA, Anti-SSA and Anti-SSB. The renal biopsy was compatible with thrombotic microangiopathy, associated with moderate interstitial fibrosis and acute tubular necrosis Case 03 - A 25-year-old male patient who had been a cocaine user for 5 years had a sudden onset of generalized disabling myalgia (especially in the lower limbs) associated with recent frontotemporal headache, palpitation, dizziness, and a non-measured febrile episode; the patient had used cocaine at the night before symptom onset. CPK was 1731 U/L.The final probable diagnosis was AKI secondary to cocaine-induced rhabdomyolysis.ConclusionsIn conclusion basically, 05 etiologies of acute kidney injury should always be remembered: rhabdomyolysis, thrombotic microangiopathy, vasculitis, acute interstitial nephritis and renal infarction. Emphasis should be given to rhabdomyolysis due to its higher prevalence. Considering the increasing rates of cocaine use, especially with the use of adulterating substances, these pathologies will likely be increasingly prevalent.

Cocaine nephropathy: A rare cause of abnormal nephrograms

“…Cocaine-induced AKI is most commonly caused by rhabdomyolysis [3] . Other reported mechanisms of cocaine-induced kidney injury include vasculitis, acute interstitial nephritis (AIN), acute tubular necrosis (ATN), thrombotic microangiopathy, and renal infarction [4] .…”

Cocaine-Induced Headache: A Review of Pathogenesis, Presentation, Diagnosis, and Management

“…In chronic cocaine users (CCUs), a headache occurs due to synaptic depletion of dopamine and serotonin causing a condition called "empty neuron", a classical migraine biochemical feature [7]. Cocaine causes vasoconstriction by activation of the sympathetic nervous system and decreases reuptake of catecholamine (noradrenaline and adrenaline), far ahead of other neurotransmitters (serotonin and dopamine), at presynaptic cleft and increases their supply at postsynaptic receptors and also releases epinephrine and norepinephrine by the adrenal medulla; moreover, it was investigated that serotonin and dopamine are also released by cocaine use [1,2,4,5]. In turn, dopamine activates alpha-1 receptors that cause powerful vasoconstriction.…”

“…There are many pathophysiological impacts caused by cocaine consumption, which include increment in oxidative stress, raised platelet activation, raised production and activation of prostaglandins, raised sympathetic activity, and endothelial dysfunction [1,2,4]. Cocaine acts the same as class I antiarrhythmic agents and local anesthetics by blocking sodium and potassium channels [2].…”

“…Cocaine use has increased across the world especially in teenagers and young adults, which contributes to lots of pathological conditions and adverse effects on health [ 1 - 3 ]. Brazil is one of the countries where cocaine use is very high [ 1 ]. Cocaine is the second most commonly used drug in the USA and Europe after marijuana [ 2 ].…”

“…Cocaine is the second most commonly used drug in the USA and Europe after marijuana [ 2 ]. In spite of its decreased consumption in the USA and almost stable in Europe, the worldwide cocaine consumption is increased because there is increased marketing of cocaine in countries where economic conditions are not good [ 1 ]. Many neurological complications are caused by vasoconstrictive effects and vasculitic damage of cocaine abuse, which includes headache, seizures, aneurysm formation, ischemic and hemorrhagic stroke, or subarachnoid hemorrhage [ 3 - 5 ].…”