Acute renal failure and other complications induced by cocaine abuse

Introduction

Cocaine is a social and medical problem. In the United States, 14.6% of a trialed population has already used cocaine. The physiopathology of the renal injury is multifactorial and largely remains unknown, and rhabdomyolysis is most frequently responsible for the renal injury.

Objectives

To describe and analyze the case of a patient with anuric acute renal failure (ARF) due to cocaine overdose. To compare and identify more recent scientific evidence for the treatment.

Materials and methods

A search and analysis of the case of a patient with anuric ARF treated in the ICU of a public emergency hospital.

Results

GC, male, 29 years old, a cocaine and marihuana user, presented a sudden condition of irritability, aggressiveness and delirious after consuming the drugs. In the subsequent days he presented hyperthermia, jaundice, oliguria, and respiratory insufficiency. He was admitted to the ICU in a severe condition with hypertension, hyperthermia and P/F = 128. Due to anuric ARF, the patient went to daily hemodialysis.

Discussion

Physiopathologic effects include hemodynamic alterations, failure in the synthesis of glomerular matrix, degradation and oxidative stress and induced renal atherogenesis.

Rhabdomyolysis is the main cause responsible for renal injury. It has a high index of mortality and its mechanisms remain unknown. There is evidence that it is intimately related to vasoconstriction due to ischemia, direct toxicity, hyperpyrexia and increased muscular activity. A quick implementation of treatment for convulsions, hyperpyrexia and agitation improves prognosis and decreases complications.

The therapeutic goals are removal of precipitating factors, handling of complications and early dialysis. The treatment of rhabdomyolysis is based on hydration, induced osmotic diuresis and urine alkalinization.

Conclusion

There are few renal injury cases reported in the literature. These generally describe renal infarction after having inhaled the drug, acute interstitial nephritis and cocaine-induced ARF with or without rhabdomyolysis. However, it is imperative that well-designed epidemiologic studies are designed to better elucidate the physiopathology of cocaine-induced renal injuries.