The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy

Abstract

PurposeThe aims of this study were to investigate the prevalence of upper tract involvement in ketamine-associated uropathy, and to determine the predictors of hydronephrosis in patients with a history of ketamine abuse. MethodsThis was a cross-sectional study of a prospective cohort of patients with ketamine-associated uropathy. Data including demographics, pattern of ketamine abuse, pelvic pain and urgency or frequency (PUF) symptom score, uroflowmetry (UFM) parameters, serum renal function, and liver function tests were collected. Upon consultation, ultrasonography was performed to assess the function of the urinary system. ResultsFrom December 2011 to October 2015, we treated 572 patients with ketamine-associated uropathy. Of these patients, 207 (36.2%) had managed to achieve abstinence at the time of their first consultation. Ninety-six patients (16.8%) in the cohort were found to have hydronephrosis on ultrasonography. Univariate analysis identified age, duration of ketamine abuse, PUF symptom score, voided volume on UFM, serum creatinine levels >100 μmol/L, and an abnormal serum liver enzyme profile as factors associated with hydronephrosis. Logistic regression revealed the following parameters to be statistically related to hydronephrosis: age (adjusted odds ratio [OR], 1.090; 95% confidence interval [CI], 1.020–1.166; P=0.012), functional bladder capacity (adjusted OR, 0.997; 95% CI, 0.995–0.999; P=0.029), serum creatinine >100 μmol/L (adjusted OR, 3.107; 95% CI, 1.238–7.794; P=0.016, and an abnormal serum liver enzyme profile (adjusted OR, 1.967; 95% CI, 1.213–3.187; P=0.006). ConclusionsKetamine-associated uropathy can involve the upper urinary tract. Patient demographics as well as investigations of UFM, renal function tests, and liver function tests may allow us to identify at-risk patients.

Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy

“…This study revealed that elevated cholestatic liver enzyme levels correlated with the degree of ketamine-associated uropathy in these chronic ketamine abusers; this finding agrees with that of a previous study [ 22 ]. In 2009, Wong et al first identified ketamine-associated hepatobiliary tract complications [ 28 ].…”

“…Since hydronephrosis appears to be involved later and less frequently, the secondary theory has been more accepted. A previous study showed that decreased functional bladder capacity was a risk factor of hydronephrosis development in chronic ketamine abusers, the result of which supports the secondary theory indirectly [ 22 ]. On this basis, some experts suggest that ketamine cystitis and ketamine hydronephrosis are characteristics of different clinical staging of ketamine-associated uropathy.…”

Management of complications of ketamine abuse: 10 years’ experience in Hong Kong

“…As well as bladder involvement, upper-urinary tract pathology presenting as hydronephrosis and flank pain has also been reported (Fig 2). A study by Yee et al 9 of 572 patients with ketamine-related LUTS found that up to 16.8% (n=96) of patients had hydronephrosis according to ultrasonography. Hydronephrosis was frequently accompanied by ureteral lesions, ureteral wall thickening, or vesicoureteral (vesicoureteric) reflux.…”

What urologists need to know about ketamine‐induced uropathy: A systematic review

“…The incidence of upper urinary tract involvement varies in the literature, ranging from 6% to 63% of the reported series 3,4,14,70‐72 . Almost half of the patients with severe cystitis (mucosal disruption, with or without bleeding) have bilateral upper urinary tract involvement, but there is usually no correlation with LUTS severity, dose, and frequency of ketamine abuse 70,71 .…”

“…Almost half of the patients with severe cystitis (mucosal disruption, with or without bleeding) have bilateral upper urinary tract involvement, but there is usually no correlation with LUTS severity, dose, and frequency of ketamine abuse 70,71 . Older age, abnormal serum enzyme profile, low bladder capacity, and high creatinine are predictors of hydronephrosis 72 …”