Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Abstract

The kidneys can be injured in diverse ways by many drugs, both legal and illegal. Novel associations and descriptions of nephrotoxic effects of common and emerging drugs of abuse have appeared over the past several years. Anabolic androgenic steroids, illicitly used by athletes and others for decades to increase muscle mass and decrease body fat, are emerging as podocyte toxins given recent descriptions of severe forms of FSGS in long-term abusers. Synthetic cannabinoids, a new group of compounds with marijuana-like effects, recently became popular as recreational drugs and have been associated with an atypical form of AKI. 3,4-Methylenedioxymethamphetamine, commonly known as ecstasy, is a widely used synthetic recreational drug with mood-enhancing properties and a constellation of toxicities that can result in death. These toxic effects include hyperthermia, hypotonic hyponatremia due to its arginine vasopressin secretagogue-like effects, rhabdomyolysis, and cardiovascular collapse. Cocaine, a serotonin-norepinephrine-dopamine reuptake inhibitor that serves as an illegal stimulant, appetite suppressant, and anesthetic, also causes vasoconstriction and rhabdomyolysis. Recent adulteration of much of the world's supply of cocaine with levamisole, an antihelminthic agent with attributes similar to but distinct from those of cocaine, appears to have spawned a new type of ANCAassociated systemic vasculitis. This review discusses the nephrotoxic effects of these common and emerging drugs of abuse, of which both community and health care providers should become aware given their widespread abuse. Future investigation into pathogenetic mechanisms associated with these drugs is critical and may provide a window into ways to lessen and even prevent the nephrotoxic effects of these drugs of abuse and perhaps allow a deeper understanding of the nephrotoxicities themselves.

Illicit drug use and acute kidney injury in patients admitted to hospital with rhabdomyolysis

“…Two recent reviews of nephrotoxicity from illicit drugs have found some evidence of direct nephrotoxicity. Where kidney biopsies have been available, renal injury other than acute tubular necrosis have included acute interstitial nephritis and glomerulonephritis as the commonest, but other findings include thrombotic microangiopathy (MDMA), vasculitis (MDMA, cocaine), vascular thrombosis or infarction (cocaine), and crystal nephropathy (heroin, cannabinoids) . The additional mechanisms of renal injury may explain why illicit drug users develop worse AKI even allowing for their higher CK.…”

Pneumomediastinum: A Complication of Synthetic Cannabinoid K2 Use

“…First is Valsalva maneuvers during inhalation of the drug and second is CHS with recurrent vomiting. Due to the relative short duration of K2 and normal lung parenchyma, it is unlikely that the patient had a direct pulmonary insult leading to barotrauma [34].…”

Quiz Page October 2015

“…Drug users can present with a wide variety of kidney involvement, including glomerular, vascular, and tubulointerstitial, which could be related to either direct or indirect nephrotoxic effects of the drug in question (Table 1). 1,2 Although the kidney complications from certain drugs (eg, cocaine) are well known, the spectrum of kidney complications from recreational drugs remain elusive due to the emergence of new agents such as synthetic cannabinoids, as well as the dynamic pattern of drug use.…”