1
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Grace Choung HY, Nast CC, Haas M, Lin M, Yamashita M, Hou J. Spectrum of Kidney Biopsy Findings Associated With Methamphetamine Use. Kidney Int Rep 2024; 9:2180-2188. [PMID: 39081731 PMCID: PMC11284416 DOI: 10.1016/j.ekir.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Methamphetamine (METH) is one of the most used drugs of abuse worldwide. However, there are few reports and series examining the toxic kidney effects of METH, and associated histopathological changes are not well-described. Methods We retrospectively identified 112 patients with a history significant for METH abuse, of whom 62 were using METH-only and 60 were using METH plus other drugs of abuse. Results In the METH-only cohort, the mean age was 41 years (interquartile range [IQR]: 33-49) and most (76%) were male. Almost all cases (97%) showed evidence of kidney dysfunction at the time of biopsy. Of the cases, 65% had proteinuria, of which 53% were nephrotic range and 10% had nephrotic syndrome. The most common biopsy diagnosis was acute tubular necrosis (ATN) (66%), of which 19% had myoglobin casts; followed by focal segmental glomerulosclerosis (FSGS) in 53% (not otherwise specified [NOS] in 76% and collapsing FSGS [cFSGS] in 18%). Biopsy findings also include tubulointerstitial nephritis (TIN) (37%), thrombotic microangiopathy (TMA) (24%), and diabetic glomerulosclerosis (DG) (31%). Glomerulonephritis (GN) was identified in one-third of cases, the most common of which were infection-related GN (IRGN) (15%) and IgA nephropathy (IgAN) (11%). Of those with GN, 64% had underlying infection. Of interest, there was increased association for myoglobinuric ATN in those with concurrent ethanol-abuse (P = 0.002). Moreover, the METH-only patients were more likely to have DG compared to those with multiple substance-use (P = 0.01). More than half of the patients demonstrated at least moderate to severe tubulointerstitial scarring and marked hypertensive vascular disease. Conclusion Most patients with METH-use present with acute kidney injury (AKI) and often have proteinuria associated with a wide spectrum of renal pathology.
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Affiliation(s)
- Hae Yoon Grace Choung
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Cynthia C. Nast
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Michifumi Yamashita
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
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2
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Sharma V, Singh TG. Drug induced nephrotoxicity- A mechanistic approach. Mol Biol Rep 2023; 50:6975-6986. [PMID: 37378746 DOI: 10.1007/s11033-023-08573-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
The main goal of the treatment of patients is its effectiveness and safety. However, all currently prescribed drugs being used also have certain adverse effects, which might be seen as an unavoidable but necessary cost of pharmacotherapy. The kidney is the primary organ for xenobiotics elimination, making it particularly susceptible to the harmful effects of drugs and their metabolites during their excretion from the body. Moreover, certain medications have a preferential nephrotoxicity potential, which means that using them increases the risk of kidney injury. Drug nephrotoxicity is, therefore, both a significant problem and a complication of pharmacotherapy. It should be noted that, there is presently no accepted definition of drug-induced nephrotoxicity and no established diagnostic criteria. The current review briefly describes the pathogenic mechanism of drug-induced nephrotoxicity, the various basic drugs with nephrotoxicity potential and the renal biomarkers for the treatment of the drug-related kidney damage.
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Affiliation(s)
- Veerta Sharma
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India, 140401
| | - Thakur Gurjeet Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India, 140401.
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3
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Kannan L. Renal manifestations of recreational drugs: A narrative review of the literature. Medicine (Baltimore) 2022; 101:e31888. [PMID: 36550840 PMCID: PMC9771315 DOI: 10.1097/md.0000000000031888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Drug abuse has become a major problem of the modern world where drug-induced kidney injury can be caused by both prescribed drugs for clinical conditions and illegal (illicit) drugs or drugs of abuse. Heroin, cocaine, nicotine and alcohol are the most commonly abused drugs but with the emergence of various synthetic drugs, numerous novel descriptions of their nephrotoxic effects have been described. This review summarizes the key renal manifestations of recreational drugs as reported in case reports and case. A comprehensive review of published case reports and case series in English language of renal toxicity related to recreational drugs/drugs of abuse was conducted using search engines like PubMed/Medline. Publications which reported renal injury with raised creatinine levels, clinically symptomatic patients, those with oliguria and with renal biopsies are chosen. The medical literature on recreational drugs is full of claims of renal complications including different glomerular diseases, acute kidney injury, rhabdomyolysis, interstitial nephritis, and debilitating irreversible conditions like renal infarction and end stage renal disease, even though the pathogenesis of drug- related renal manifestations are not available for all the newer agents. The outcome of this review paper will help multidisciplinary physicians to understand the renal side effects of recreational drugs, their pathophysiology, and most importantly, the clinical presentations of renal dysfunction in relation each drug. Emphasizing these adverse effects will prevent future unfavorable outcomes.
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Affiliation(s)
- Lakshmi Kannan
- Department of Nephrology, Pikeville Medical Center, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, KY
- * Correspondence: Lakshmi Kannan, Department of Internal Medicine, Division of Nephrology, Pikeville Medical Center, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, KY 41501 (e-mail: )
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4
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Drugs of abuse and kidney toxicity. CURRENT OPINION IN TOXICOLOGY 2022. [DOI: 10.1016/j.cotox.2022.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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5
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LeSaint KT, Yin S, Sharma A, Avery BA, McCurdy CR, Waksman JC. Acute Renal Insufficiency Associated With Consumption of Hydrocodone- and Morphine-Adulterated Kratom (Mitragyna Speciosa). J Emerg Med 2022; 63:e28-e30. [PMID: 35940982 DOI: 10.1016/j.jemermed.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Kratom (Mitragyna speciosa), an evergreen tree native to Southeast Asia, contains alkaloids that cause both stimulant and opioid-like effects. In the United States, its use continues to grow. Kratom products, however, are unregulated and nonstandardized, and reports of adulteration have been described previously. CASE REPORT A 21-year-old African-American woman with a history of occasional headaches and self-treatment with internet-purchased kratom presented to the emergency department with the chief symptoms of nausea, vomiting, and left flank pain. Laboratory tests showed a markedly elevated serum creatinine of 4.25 mg/dL (reference range 0.6-1.2 mg/dL) and proteinuria. A computed tomography scan of the abdomen and pelvis was unrevealing. A standard urine screen for drugs of abuse was positive for opiates. A confirmatory testing revealed the presence of hydrocodone and morphine in the urine. Hydrocodone, morphine, and mitragynine were identified in a sample of kratom leaves provided by the patient. The patient's renal function improved with supportive care and normalized 1 month post discharge after kratom discontinuation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite widespread use, relatively little is known about kratom's adverse effects, particularly regarding its potential to cause renal insufficiency. This case illustrates the vital importance of recognizing that adulteration of unregulated products is certainly a possibility and clinicians may continue to see a rise in adverse effects, given kratom's increasing popularity.
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Affiliation(s)
- Kathy T LeSaint
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Shan Yin
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio; Drug and Poison Information Center, Cincinnati, Ohio
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Bonnie A Avery
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Christopher R McCurdy
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Javier C Waksman
- Department of Internal Medicine, University of California, San Francisco, San Francisco, California
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6
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Cutrim ÉMM, Neves PDMDM, Campos MAG, Wanderley DC, Teixeira-Júnior AAL, Muniz MPR, Ladchumananandasivam FR, Gomes OV, Vasco RFV, Brito DJDA, Lages JS, Salgado-Filho N, Guedes FL, de Almeida JB, Magalhães M, Araújo SDA, Silva GEB. Collapsing Glomerulopathy: A Review by the Collapsing Brazilian Consortium. Front Med (Lausanne) 2022; 9:846173. [PMID: 35308512 PMCID: PMC8927620 DOI: 10.3389/fmed.2022.846173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/08/2022] [Indexed: 01/10/2023] Open
Abstract
Collapsing glomerulopathy (CG) is a clinicopathologic entity characterized by segmentar or global collapse of the glomerulus and hypertrophy and hyperplasia of podocytes. The Columbia classification of 2004 classified CG as a histological subtype of focal segmental glomerulosclerosis (FSGS). A growing number of studies have demonstrated a high prevalence of CG in many countries, especially among populations with a higher proportion of people with African descent. The present study is a narrative review of articles extracted from PubMed, Medline, and Scielo databases from September 1, 2020 to December 31, 2021. We have focused on populational studies (specially cross-sectional and cohort articles). CG is defined as a podocytopathy with a distinct pathogenesis characterized by strong podocyte proliferative activity. The most significant risk factors for CG include APOL1 gene mutations and infections with human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. CG typically presents with more severe symptoms and greater renal damage. The prognosis is notably worse than that of other FSGS subtypes.
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Affiliation(s)
| | | | | | - Davi Campos Wanderley
- Nephropathology Institute, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Orlando Vieira Gomes
- University Hospital, Federal University of Vale do São Francisco, Petrolina, Brazil
| | | | | | | | | | - Felipe Leite Guedes
- University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Marcelo Magalhães
- Laboratory of Genomic and Histocompatibility Studies, University Hospital, Federal University of Maranhão, São Luís, Brazil
| | | | - Gyl Eanes Barros Silva
- University Hospital, Federal University of Maranhão, São Luís, Brazil
- *Correspondence: Gyl Eanes Barros Silva,
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7
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Opioids for chronic pain management in patients with dialysis-dependent kidney failure. Nat Rev Nephrol 2022; 18:113-128. [PMID: 34621058 PMCID: PMC8792317 DOI: 10.1038/s41581-021-00484-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/30/2022]
Abstract
Chronic pain is highly prevalent among adults treated with maintenance haemodialysis (HD) and has profound negative effects. Over four decades, research has demonstrated that 50-80% of adult patients treated with HD report having pain. Half of patients with HD-dependent kidney failure (HDKF) have chronic moderate-to-severe pain, which is similar to the burden of pain in patients with cancer. However, pain management in patients with HDKF is often ineffective as most patients report that their pain is inadequately treated. Opioid analgesics are prescribed more frequently for patients receiving HD than for individuals in the general population with chronic pain, and are associated with increased morbidity, mortality and health-care resource use. Furthermore, current opioid prescribing patterns are frequently inconsistent with guideline-recommended care. Evidence for the effectiveness of opioids in pain management in general, and in patients with HDKF specifically, is lacking. Nonetheless, long-term opioid therapy has a role in the treatment of some patients when used selectively, carefully and combined with an ongoing assessment of risks and benefits. Here, we provide a comprehensive overview of the use of opioid therapy in patients with HDKF and chronic pain, including a discussion of buprenorphine, which has potential as an analgesic option for patients receiving HD owing to its unique pharmacological properties.
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8
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Hakroush S, Wulf S, Gallwas J, Tampe B. Case Report: Collapsing Focal Segmental Glomerulosclerosis After Initiation of Ado-Trastuzumab Emtansine Therapy. Front Oncol 2021; 11:796223. [PMID: 34912725 PMCID: PMC8667226 DOI: 10.3389/fonc.2021.796223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023] Open
Abstract
Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate consisting of the monoclonal antibody trastuzumab linked to the maytansinoid DM1 with potential antineoplastic activity and is approved for human epidermal growth factor receptor 2 (HER2)-positive breast cancer. An analysis of the US Food and Drug Administration (FDA) Adverse Event Reporting System identified 124/1,243 (10%) renal adverse events for trastuzumab. However, there are no published case reports describing kidney biopsy findings related to nephrotoxicity of either trastuzumab or T-DM1. We report kidney biopsy findings in a case of nephrotic range proteinuria due to collapsing focal segmental glomerulosclerosis (FSGS) and tubular injury after initiation of T-DM1 therapy. After systematic exclusion of other causes, it is likely that the observed collapsing FSGS was associated with the prior initiation of T-DM1 therapy. This is further supported by the clinical course with improvement of proteinuria and kidney function 3 weeks after discontinuation of T-DM1 therapy without further specific treatment. In summary, we provide the first report of kidney biopsy findings in a case of nephrotic range proteinuria after initiation of T-DM1 therapy due to collapsing FSGS. This issue is especially relevant since T-DM1 is widely used, and nephrologists have to be aware of this potentially rare but severe complication.
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Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Svenja Wulf
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Gallwas
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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9
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Xiao N, Chai H, Omoloja A. Substance use among adolescents and young adults with chronic kidney disease or kidney failure. Pediatr Nephrol 2021; 36:3585-3593. [PMID: 33686466 DOI: 10.1007/s00467-021-05001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Substance use, a significant public health issue, is well described in the adult chronic kidney disease (CKD) population. Knowledge about substance use in the adolescent and young adult (AYA) CKD population such as prevalence, impact on kidney function, medication adherence, and psychosocial well-being remain largely unknown. Awareness of and inquiring about substance use is paramount to providing evidence-based care and preparation to transition to adult-focused health services. The authors in this review identify commonly used substances (alcohol, tobacco, marijuana, etc.) and how they impact kidney function and care of the AYA with CKD or kidney failure. Recommendations for screening and intervention strategies are provided.
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Affiliation(s)
- Nianzhou Xiao
- Department of Nephrology, Valley Children's Healthcare, Madera, CA, USA
| | - Hua Chai
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Abiodun Omoloja
- Department of Pediatrics, Wright State University, Dayton, OH, USA.
- Division of Nephrology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
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10
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Yang CW, Li S, Dong Y, Paliwal N, Wang Y. Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis. J Clin Med 2021; 10:jcm10091950. [PMID: 34062839 PMCID: PMC8125267 DOI: 10.3390/jcm10091950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR] 3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.
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Affiliation(s)
- Chien-Wen Yang
- Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA;
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
- Correspondence:
| | - Yishan Dong
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA;
| | - Nitpriya Paliwal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St, Springfield, MA 01104, USA;
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11
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Podestà MA, Ponticelli C. Autoimmunity in Focal Segmental Glomerulosclerosis: A Long-Standing Yet Elusive Association. Front Med (Lausanne) 2020; 7:604961. [PMID: 33330569 PMCID: PMC7715033 DOI: 10.3389/fmed.2020.604961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 01/17/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a histological term that describes a pathologic renal entity affecting both adults and children, with a wide array of possible underlying etiologies. Podocyte damage with scarring, the hallmark of this condition, leads to altered permeability of the glomerular barrier, which may result in massive proteinuria and relentless renal function deterioration. A definite cause of focal segmental glomerulosclerosis can be confirmed in a minority of cases, while most forms have been traditionally labeled as primary or idiopathic. Despite this definition, increasing evidence indicates that primary forms are a heterogenous group rather than a single disease entity: several circulating factors that may affect glomerular permeability have been proposed as potential culprits, and both humoral and cellular immunity have been implicated in the pathogenesis of the disease. Consistently, immunosuppressive drugs are considered as the cornerstone of treatment for primary focal segmental glomerulosclerosis, but response to these agents and long-term outcomes are highly variable. In this review we provide a summary of historical and recent advances on the pathogenesis of primary focal segmental glomerulosclerosis, focusing on implications for its differential diagnosis and treatment.
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12
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Lescure FX, Fellahi S, Pialoux G, Bastard JP, Eme AL, Esteve E, Lebrette MG, Guiard-Schmid JB, Capeau J, Ronco P, Costagliola D, Plaisier E. Prevalence of tubulopathy and association with renal function loss in HIV-infected patients. Nephrol Dial Transplant 2020; 35:607-615. [PMID: 31071216 DOI: 10.1093/ndt/gfz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The incidence of chronic kidney disease (CKD) is 10 times higher in human immunodeficiency virus (HIV)-infected patients than in the general population. We explored the prevalence and determinants of proximal tubular dysfunction (PTD) in HIV-infected individuals, and assessed the impact of the tubulopathy on the estimated glomerular filtration rate (eGFR) outcome. METHODS A cohort study was performed on 694 outpatients followed in a French centre to analyse the prevalence of PTD, the diagnosis performance of screening tools and the associated factors. eGFR was prospectively evaluated to analyse the predictive value of the tubulopathy on eGFR decrease. RESULTS At inclusion, 14% of the patients presented with PTD and 5% with CKD. No individual tubular marker, including non-glomerular proteinuria, glycosuria dipstick or hypophosphataemia, registered sufficient performance to identify PTD. We found a significant interaction between tenofovir disoproxil fumarate exposure and ethnicity (P = 0.03) for tubulopathy risk. Tenofovir disoproxil fumarate exposure was associated with PTD in non-Africans [adjusted odds ratio (aOR) = 4.71, P < 10-3], but not in patients of sub-Saharan African origin (aOR = 1.17, P = 0.73). Among the 601 patients followed during a median of 4.3 years, 13% experienced an accelerated eGFR decline. Unlike microalbuminuria and glomerular proteinuria, tubulopathy was not associated with accelerated eGFR decline. CONCLUSION PTD is not rare in HIV-infected individuals but is less frequent in sub-Saharan African patients and is associated with tenofovir disoproxil fumarate exposure only in non-Africans. Its diagnosis requires multiple biochemical testing and it is not associated with an accelerated eGFR decline.
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Affiliation(s)
- François-Xavier Lescure
- Department of Infectious and Tropical Diseases, Bichat Hospital, AP-HP, Paris, France.,Department of Infectious and Tropical Diseases, Tenon Hospital, AP-HP, Paris, France.,Inserm, IAME, UMRS 1137, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Soraya Fellahi
- Department of Biochemistry and Hormonology, Tenon Hospital, AP-HP, Paris, France.,Inserm UMR, Centre de Recherche Saint-Antoine, UMRS 938, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, UPMC, Paris, France.,Sorbonne Universités, Paris, France
| | - Gilles Pialoux
- Department of Infectious and Tropical Diseases, Tenon Hospital, AP-HP, Paris, France.,Inserm, IAME, UMRS 1137, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France.,Department of Biochemistry and Hormonology, Tenon Hospital, AP-HP, Paris, France.,Inserm UMR, Centre de Recherche Saint-Antoine, UMRS 938, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, UPMC, Paris, France.,Sorbonne Universités, Paris, France
| | - Jean-Philippe Bastard
- Department of Biochemistry and Hormonology, Tenon Hospital, AP-HP, Paris, France.,Inserm UMR, Centre de Recherche Saint-Antoine, UMRS 938, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, UPMC, Paris, France.,Sorbonne Universités, Paris, France
| | - Anne-Line Eme
- Department of Infectious and Tropical Diseases, Bichat Hospital, AP-HP, Paris, France
| | - Emmanuel Esteve
- Department of Nephrology and Dialysis, Tenon Hospital, AP-HP, Paris, France
| | - Marie-Gisèle Lebrette
- Department of Infectious and Tropical Diseases, Tenon Hospital, AP-HP, Paris, France
| | | | - Jacqueline Capeau
- Department of Biochemistry and Hormonology, Tenon Hospital, AP-HP, Paris, France.,Inserm UMR, Centre de Recherche Saint-Antoine, UMRS 938, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, UPMC, Paris, France.,Sorbonne Universités, Paris, France
| | - Pierre Ronco
- Sorbonne Universités, Paris, France.,Department of Nephrology and Dialysis, Tenon Hospital, AP-HP, Paris, France.,Inserm, UMRS 1155, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, Paris, France.,INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Emmanuelle Plaisier
- Sorbonne Universités, Paris, France.,Department of Nephrology and Dialysis, Tenon Hospital, AP-HP, Paris, France.,Inserm, UMRS 1155, Paris, France
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13
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14
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Pavlek LR, Dillard J, Rogers LK. The role of oxidative stress in toxicities due to drugs of abuse. CURRENT OPINION IN TOXICOLOGY 2020. [DOI: 10.1016/j.cotox.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Drogenassoziierte Nephropathien. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Abstract
Abstract
Cocaine is a natural alkaloid extracted from the leaves of the South American plant Erythroxylum coca or synthesized chemically. After cannabis, it is the second most frequently abused recreational substance worldwide. Cocaine can affect every tissue and organ within the human body, including the kidneys, causing tissue ischemia due to vasoconstriction, endothelial dysfunction and damage, procoagulant activity and oxidative stress with subsequent ischemic infarctions and fibrosis. The renal changes in cocaine abuse and addiction are due to rhabdomyolysis, ischemic, hypertensive, and inflammatory changes with the development of cell proliferation and fibrosis. The authors present three patients with cocaine-associated renal damage and discuss the underlying mechanisms of cocaine-induces tissue changes.
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17
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Filho JCCL, Ogawa MY, de Souza Andrade TH, de Andrade Cordeiro Gadelha S, Fernandes PFCBC, Queiroz AL, Daher EDF. Spectrum of acute kidney injury associated with cocaine use: report of three cases. BMC Nephrol 2019; 20:99. [PMID: 30894132 PMCID: PMC6427899 DOI: 10.1186/s12882-019-1279-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/06/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The 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 PRESENTATION Case 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. CONCLUSIONS In 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.
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Affiliation(s)
- José Célio Costa Lima Filho
- Nephrology Training Program, Department of Nephrology, Walter Cantídio University Hospital, Fortaleza, Brazil.
| | - Maurício Yukio Ogawa
- Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Tacilla Hanny de Souza Andrade
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Estadual University of Ceará, Fortaleza, Brazil
| | | | | | - Anaiara Lucena Queiroz
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Estadual University of Ceará, Fortaleza, Brazil.,Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Le Foll B, French L. Transcriptomic Characterization of the Human Habenula Highlights Drug Metabolism and the Neuroimmune System. Front Neurosci 2018; 12:742. [PMID: 30429765 PMCID: PMC6220030 DOI: 10.3389/fnins.2018.00742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
Due to size and accessibility, most information about the habenula is derived from rodent studies. To better understand the molecular signature of the habenula we characterized the genes that have high expression in the habenula. We compared anatomical expression profiles of three normal adult human brains and four fetal brains. We used gene set enrichment analyses to determine if genes annotated to specific molecular functions, cellular components, and biological processes are enriched in the habenula. We also tested gene sets related to depression and addiction to determine if they uniquely involve the habenula. As expected, we observed high habenular expression of GPR151, nicotinic cholinergic receptors, and cilia-associated genes (medial division). Genes identified in genetic studies of smoking and associated with nicotine response were enriched in the habenula. Genes associated with major depressive disorder did not have enriched expression in the habenula but genes negatively correlated with hedonic well-being were, providing a link to anhedonia. We observed enrichment of genes associated with diseases that are comorbid with addictions (hematopoiesis, thrombosis, liver cirrhosis, pneumonia, and pulmonary fibrosis) and depression (rheumatoid arthritis, multiple sclerosis, and kidney disease). These inflammatory diseases mark a neuroimmune signature that is supported by genes associated with mast cells, acute inflammatory response, and leukocyte migration. We also found enrichment of cytochrome p450 genes suggesting the habenula is uniquely sensitive to endogenous and xenobiotic compounds. Our results suggest the habenula receives negative reward signals from immune and drug processing molecules. This is consistent with the habenular role in the "anti-reward" system and suggests it may be a key bridge between autoimmune disorders, drug use, and psychiatric diseases.
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Affiliation(s)
- Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Leon French
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Matłosz B, Pietraszkiewicz E, Firląg-Burkacka E, Grycner E, Horban A, Kowalska JD. Risk factors for kidney disease among HIV-1 positive persons in the methadone program. Clin Exp Nephrol 2018; 23:342-348. [PMID: 30218298 DOI: 10.1007/s10157-018-1644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Kidney injury is a serious comorbidity among HIV-infected patients. Intravenous drug use is listed as one of the risk factors for impaired renal function; however, this group is rarely assessed for specific renal-related risks. METHODS Patients attending methadone program from 1994 to 2015 were included in the study. Data collected included demographic data, laboratory tests, antiretroviral treatment history, methadone dosing and drug abstinence. Patients' drug abstinence was checked monthly on personnel demand. We have evaluated two study outcomes: (1) having at least one or (2) three eGFR < 60 ml/min (MDRD formula). RESULTS In total, 267 persons, with 2593 person-years of follow-up were included into analyses. At the time of analyses, 251 (94%) were on antiretroviral therapy (ARV). Fifty-two (19.5%) patients had 1eGFR and 20 (7.5%) 3eGFR < 60. In univariate analysis, factors significantly increasing the odds of impaired renal function were: female gender, detectable HIV RNA on ART, age at registration per 5 years older, atazanavir use and time on antiretroviral treatment per 1 year longer. In the multivariate model, only female gender (OR 4.7; p = 0.002), time on cART (OR 1.11; p = 0.01) and baseline eGFR (OR 0.71; p = 0.001) were statistically significant. CONCLUSIONS We have demonstrated a high rate of kidney function impairment among HIV-1 positive patients in the methadone program. All risk factors for decreased eGFR in this subpopulation of patients were similar to those described for general HIV population with very high prevalence in women. These findings imply the need for more frequent kidney function monitoring in this subgroup of patients.
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Affiliation(s)
- Bartłomiej Matłosz
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland.
| | - Ewa Pietraszkiewicz
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Ewa Firląg-Burkacka
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Ewa Grycner
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Andrzej Horban
- Department for Adults Infectious Diseases, Medical University of Warsaw, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Justyna D Kowalska
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland.,Department for Adults Infectious Diseases, Medical University of Warsaw, ul. Wolska 37, 01-201, Warsaw, Poland
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Lu M, Wang P, Ge Y, Dworkin L, Brem A, Liu Z, Gong R. Activation of mineralocorticoid receptor by ecdysone, an adaptogenic and anabolic ecdysteroid, promotes glomerular injury and proteinuria involving overactive GSK3β pathway signaling. Sci Rep 2018; 8:12225. [PMID: 30111886 PMCID: PMC6093907 DOI: 10.1038/s41598-018-29483-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023] Open
Abstract
Ecdysone is an arthropod molting hormone and has been marketed as a non-androgenic natural anabolic and adaptogen. However, the safety profile of ecdysone is largely undetermined. After ecdysone treatment for 2 weeks, mice developed albuminuria with histologic signs of glomerular injury, including hypertrophy, mesangial expansion, mild glomerulosclerosis and podocyte injury. A direct glomerulopathic activity of ecdysone seems to contribute, since addition of ecdysone to cultured glomerular cells induced cytopathic changes, including apoptosis, activation of mesangial cells, podocyte shape changes and a decreased expression of podocyte markers. To explore the molecular target responsible for the pathogenic actions, we employed an in silico modeling system of compound-protein interaction and identified mineralocorticoid receptor (MR) as one of the top-ranking proteins with putative interactions with ecdysone. The molecular structure of ecdysone was highly homologous to mineralocorticoids, like aldosterone. Moreover, ecdysone was capable of both inducing and activating MR, as evidenced by MR nuclear accumulation in glomerular cells both in vitro and in vivo following ecdysone treatment. Mechanistically, glycogen synthase kinase (GSK) 3β, which has been recently implicated in pathogenesis of glomerular injury and proteinuria, was hyperactivated in glomeruli in ecdysone-treated mice, concomitant with diverse glomerulopathic changes. In contrast, spironolactone, a selective blockade of MR, largely abolished the cytopathic effect of ecdysone in vitro and attenuated albuminuria and glomerular lesions in ecdysone treated mice, associated with a mitigated GSK3β overactivity in glomeruli. Altogether, ecdysone seems able to activate MR and thereby promote glomerular injury and proteinuria involving overactive GSK3β pathway signaling.
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Affiliation(s)
- Minglei Lu
- Institute of Nephrology, Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Division of Kidney Disease and Hypertension, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, United States
- Division of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, United States
| | - Pei Wang
- Institute of Nephrology, Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Division of Kidney Disease and Hypertension, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, United States
| | - Yan Ge
- Division of Kidney Disease and Hypertension, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, United States
| | - Lance Dworkin
- Division of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, United States
| | - Andrew Brem
- Division of Kidney Disease and Hypertension, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, United States
| | - Zhangsuo Liu
- Institute of Nephrology, Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Rujun Gong
- Institute of Nephrology, Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Division of Kidney Disease and Hypertension, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, United States.
- Division of Nephrology, Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, United States.
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21
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Phenotypic effects of chronic and acute use of methiopropamine in a mouse model. Int J Legal Med 2018; 133:811-820. [DOI: 10.1007/s00414-018-1891-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/17/2018] [Indexed: 01/30/2023]
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22
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Madakshira MG, Bal A, ShivaPrakash, Rathi M, Vijayvergiya R. Candida parapsilosis endocarditis in an intravenous drug abuser: an autopsy report. Cardiovasc Pathol 2018; 36:30-34. [PMID: 30005395 DOI: 10.1016/j.carpath.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022] Open
Abstract
Candida parapsilosis is a rare cause of endocarditis, which is seen to affect the native valves in patients who are known intravenous drug abusers or following contamination during surgery for prosthetic valves. We discuss a unique constellation of autopsy findings in a 35-year-old chronic opium abuser who presented with left-sided weakness followed by low-grade fever. He was diagnosed to have C. parapsilosis native valve endocarditis with septic emboli involving the myocardial vessels, left middle cerebral artery, spleen, and common iliac artery. In addition, autopsy highlighted a right basal ganglia infarct, focal segmental glomerulonephritis, and talc granulomatosis in the lungs and liver.
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Affiliation(s)
- Manoj Gopal Madakshira
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India.
| | - ShivaPrakash
- Department of Medical Microbiology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Sciences & Research, [PGIMER], Sector-12, Chandigarh, 160012, India
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Bundy JD, Bazzano LA, Xie D, Cohan J, Dolata J, Fink JC, Hsu CY, Jamerson K, Lash J, Makos G, Steigerwalt S, Wang X, Mills KT, Chen J, He J. Self-Reported Tobacco, Alcohol, and Illicit Drug Use and Progression of Chronic Kidney Disease. Clin J Am Soc Nephrol 2018; 13:993-1001. [PMID: 29880471 PMCID: PMC6032576 DOI: 10.2215/cjn.11121017] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/05/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies suggest that tobacco, alcohol, and illicit drug use is associated with CKD. We examined the associations of substance use with CKD progression and all-cause mortality among patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Renal Insufficiency Cohort Study is a prospective, longitudinal cohort study among 3939 participants with CKD in the United States. Self-reported tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug (cocaine, heroin, or methamphetamine) use were obtained at baseline and annual follow-up visits. CKD progression was defined as incident ESKD or halving of eGFR. Substance use was modeled as the cumulative average exposure to capture both recent and long-term use in multivariable time-dependent Cox regression. RESULTS Over a median 5.5-year follow-up, 1287 participants developed CKD progression, and 1001 died. Baseline proportions of tobacco smoking, alcohol drinking, marijuana use, and hard illicit drug use were 13%, 20%, 33%, and 12%, respectively. Compared with nonsmoking throughout follow-up, multivariable-adjusted hazard ratios for persistent tobacco smoking were 1.02 (95% confidence interval, 0.86 to 1.21) for CKD progression and 1.86 (95% confidence interval, 1.54 to 2.24) for all-cause mortality. Compared with nondrinking throughout follow-up, multivariable-adjusted hazard ratios for persistent alcohol drinking were 1.06 (95% confidence interval, 0.88 to 1.29) for CKD progression and 0.73 (95% confidence interval, 0.58 to 0.91) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent marijuana use were 0.94 (95% confidence interval, 0.82 to 1.07) for CKD progression and 1.11 (95% confidence interval, 0.96 to 1.30) for all-cause mortality. Compared with nonuse throughout follow-up, multivariable-adjusted hazard ratios for persistent hard illicit drug use were 1.25 (95% confidence interval, 1.00 to 1.55) for CKD progression and 1.41 (95% confidence interval, 1.10 to 1.81) for all-cause mortality. CONCLUSIONS Hard illicit drug use is associated with higher risk of CKD progression and all-cause mortality, tobacco smoking is associated with higher risk of all-cause mortality, and alcohol drinking is associated with lower risk of all-cause mortality among patients with CKD.
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Affiliation(s)
- Joshua D. Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Dawei Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Janet Cohan
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Jacqueline Dolata
- Division of Nephrology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey C. Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chi-yuan Hsu
- Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Kenneth Jamerson
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - James Lash
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Gail Makos
- Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan; and
| | - Susan Steigerwalt
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Xue Wang
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine T. Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - the CRIC Study Investigators
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Medicine, University of Illinois, Chicago, Illinois
- Division of Nephrology, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Division of Nephrology, University of California San Francisco, San Francisco, California
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan; and
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan
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24
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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25
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Steinmetz A, Steffens L, Morás AM, Prezzi F, Braganhol E, Saffi J, Ortiz RS, Barros HMT, Moura DJ. In vitro model to study cocaine and its contaminants. Chem Biol Interact 2018; 285:1-7. [PMID: 29475069 DOI: 10.1016/j.cbi.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 12/18/2022]
Abstract
Cocaine is one of the most popular illicit drug worldwide. Due its great addictive potential, which leads to euphoria and hyperactivity, it is considered a public health concern. At the central nervous system, the drug acts inhibiting catecholamine re-uptake. It is now known that in addition to the toxicity of the drug itself, the contaminants present in the street drug have raised concern about the harmful effects on health. Toxicological in vivo and in vitro studies have demonstrated the toxic effects of cocaine correlated with the generation of reactive oxygen species (ROS), which in turn lead to oxidative damage to the cells. Therefore the aim of this work was to propose an in vitro model that reunites the main parameters of toxicity of the cocaine already observed in the literature so far, and we tested this model using cocaine and seizure cocaine sample (SCS), kindly provided by Federal Police of Brazil. For that, we used a C6 glioblastoma cells and evaluated cell death, oxygen reactive species induction, oxidation of macromolecules as membrane lipids and DNA and loss of mitochondrial membrane potential after cocaine exposure. The results showed that cocaine can decrease cellular viability in a dose-dependent way in the C6 cell immortalized and astrocytes primary culture. Cocaine also induced cellular death by apoptosis. However, in the seizure cocaine sample (SCS), the predominant cell death was due to necrosis. Using dichlorofluorescein (DCF) assay, we confirmed ROS production after cocaine exposition. In agreement with these findings, occurred an increasing in MDA production, as well as increased superoxide dismutase (SOD) and catalase (CAT) activity. The induction of DNA damage was observed after cocaine. Our results demonstrate the occurrence of mitochondrial dysfunction by depolarization of mitochondrial membrane as a consequence of cocaine treatment. In summary, these results demonstrated that cocaine can induce reactive oxygen species formation, leading to oxidative stress. As a consequence of this unbalance, DNA damage, lipidic peroxidation and loss of mitochondrial membrane occurred, which could be an answer to cell death observed.
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Affiliation(s)
- Aline Steinmetz
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Luiza Steffens
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Ana Moira Morás
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Flávia Prezzi
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Elizandra Braganhol
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Jenifer Saffi
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Rafael Scorsatto Ortiz
- Divisão Técnica-Científica, Policia Federal do Brasil, Porto Alegre, RS, 90160-092, Brazil.
| | - Helena M T Barros
- Laboratório de Neurofarmacologia, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Dinara Jaqueline Moura
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
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Mansoor K, Kheetan M, Shahnawaz S, Shapiro AP, Patton-Tackett E, Dial L, Rankin G, Santhanam P, Tzamaloukas AH, Nadasdy T, Shapiro JI, Khitan ZJ. Systematic review of nephrotoxicity of drugs of abuse, 2005-2016. BMC Nephrol 2017; 18:379. [PMID: 29287591 PMCID: PMC5747941 DOI: 10.1186/s12882-017-0794-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes. METHODS We conducted a systematic review of published case reports, case series, and cross sectional studies of nephrotoxicities related to drugs of abuse. Literature review was conducted using PubMed/Medline from January 1, 2005 -December 31, 2016 to search for publications related to drug abuse with a defined renal outcome. Publications which reported renal injury in relation to the use of illicit drugs were selected, specifically those cases with raised creatinine levels, clinically symptomatic patients, for instance those with oliguria and proven renal biopsies. RESULTS A total of 4798 publications were reviewed during the search process and PRISMA flow chart and Moose protocol regarding systematic reviews were followed. 110 articles were shortlisted for the review. A total of 169 cases from case reports and case series, and 14 case studies were analyzed. Renal manifestations of specific illicit drug abuse were included in this review. CONCLUSION Based on the evidence presented, a wide range of renal manifestations were found to be associated with drug abuse. If the trend of increasing use of illicit drug use continues, it will put a significant percentage of the population at an elevated risk for poor renal outcomes. This study is limited by the nature of the literature reviewed being primarily case reports and case series.
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Affiliation(s)
- Kanaan Mansoor
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Murad Kheetan
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Saba Shahnawaz
- Aga Khan University Hospital, Stadium Road, Karachi, 74800 Pakistan
| | - Anna P. Shapiro
- The Case Western Reserve University, Cleveland, OH 44106 USA
| | - Eva Patton-Tackett
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Larry Dial
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Gary Rankin
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | | | | | | | - Joseph I. Shapiro
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Zeid J. Khitan
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
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Scott JK, Taylor DM, Dudley CRK. Intravenous drug users who require dialysis: causes of renal failure and outcomes. Clin Kidney J 2017; 11:270-274. [PMID: 29644070 PMCID: PMC5887625 DOI: 10.1093/ckj/sfx090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/13/2017] [Indexed: 01/28/2023] Open
Abstract
Background Intravenous drug use is associated with progressive kidney disease of several aetiologies. It is associated with behavioural and lifestyle characteristics that make the provision of renal replacement therapies (RRTs) challenging. We observed that patients who use intravenous drugs [people who inject drugs (PWID)] present late to renal services and struggle to engage with treatment. We describe the experience of a UK centre providing renal services to a mixed city and rural population. Methods A review of electronic patient records (2003-16) was performed to identify patients actively using intravenous drugs at the time of dialysis initiation. Descriptive statistics were used to describe aetiology, treatment, complications and prognosis. Results Twenty-three patients were identified; 15 had a biopsy-proven diagnosis of AA amyloidosis. The median time from presentation to dialysis initiation was 47 days [interquartile range (IQR) 8-147.5]. Hepatitis C infection, venous thromboembolism and mental health disorders were common comorbidities. Eight patients attempted peritoneal dialysis; all failed after a median of 30 days (IQR 21.75-83). One-year survival was 65% (95% confidence interval 42-80), significantly lower than 2013 UK renal registry statistics for incident haemodialysis patients <65 years of age (94.2%). Conclusions PWID who develop end-stage kidney disease in our region predominantly have AA amyloidosis. Most present late to renal services and have poor outcomes on all forms of RRT. Rates of transplantation are low. Management challenges include coexisting alcohol and mental health problems, low socio-economic status, contamination of intravenous dialysis access and chaotic lifestyles. Multidisciplinary management with enhanced social support may be beneficial in improving outcomes for this patient group.
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Affiliation(s)
- Jemima K Scott
- Richard Bright Renal Service, North Bristol NHS Trust, UK
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Nanavati A, Herlitz LC. Tubulointerstitial Injury and Drugs of Abuse. Adv Chronic Kidney Dis 2017; 24:80-85. [PMID: 28284383 DOI: 10.1053/j.ackd.2016.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 01/26/2023]
Abstract
Drug abuse is widespread in many populations, and patients abusing illicit substances are at a significantly increased risk of kidney injury. The tubulointerstitial compartment is a common target of these nephrotoxic agents. This review will cover some of the common illicit drugs and will focus on the tubulointerstitial injuries seen in the setting of drug abuse. Agents addressed in this review are synthetic cannabinoids, "bath salts," ecstasy, anabolic steroids, inhaled solvents, heroin, and cocaine. The most frequent biopsy findings are those of acute tubular necrosis and acute interstitial nephritis. Unfortunately, histology is often unable to sufficiently narrow the differential diagnosis and point to a single likely cause. A high suspicion for drug abuse as a potential cause of kidney injury is needed to identify the patients for whom this is the cause of their kidney failure. Toxicology screens are often of little use in identifying patients using emerging drugs of abuse.
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Riley ED, Hsue PY, Vittinghoff E, Wu AHB, Coffin PO, Moore PK, Lynch KL. Higher prevalence of detectable troponin I among cocaine-users without known cardiovascular disease. Drug Alcohol Depend 2017; 172:88-93. [PMID: 28157591 PMCID: PMC5464776 DOI: 10.1016/j.drugalcdep.2016.11.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND While cocaine use is an established risk factor for acute cardiovascular complications, associations between cocaine use and markers of cardiac injury outside of acute hospital presentation remain poorly characterized. We leveraged advances in cardiac troponin (cTnI) testing to assess low but clinically meaningful levels of cardiac injury among cocaine users and non-users. METHODS We conducted a case control study comparing cTnI levels by the presence of cocaine among patients presenting for non-cardiac care in an urban safety net hospital. Samples were chosen sequentially among those for which urine drug screens were ordered by providers hospital-wide. RESULTS During 2015, 14% of all hospital drug screens ordered were cocaine-positive. Among unique persons providing cocaine-positive (N=100) and cocaine-negative (N=100) samples, 37% were female, 45% were African-American and the median age was 51. Detectable cTnI (> 0.02ng/mL) was observed in 21 samples (11%). It was more common in subjects using cocaine (Adjusted OR=2.81; 95% CI=1.03-7.65), but not other drugs. Moreover, there was a significant correlation between concentrations of cTnI and the cocaine metabolite, benzoylecgonine (Spearman Correlation=0.34, p<0.01). CONCLUSIONS Among urban safety net hospital patients, 11% had detectable cTnI, and cTnI concentration was significantly correlated with benzoylecgonine concentration. While these preliminary results require additional confirmation, they suggest the potential utility of considering cocaine use as more than just an episodic exposure leading to acute cardiac events. The consideration of cocaine use as an ongoing chronic exposure leading to subclinical cardiac injury may improve risk-stratification and patient outcomes in populations where cocaine use is high.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
| | - Phillip O Coffin
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Peter K Moore
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Hospital Medicine, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
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Novick T, Liu Y, Alvanzo A, Zonderman AB, Evans MK, Crews DC. Lifetime Cocaine and Opiate Use and Chronic Kidney Disease. Am J Nephrol 2016; 44:447-453. [PMID: 27788520 DOI: 10.1159/000452348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND More than 50% of American adolescents and adults report having used illicit drugs in their lifetime. We examined the association of lifetime opiate and cocaine use with reduced kidney function, albuminuria and rapid kidney function decline among urban-dwelling adults. METHODS Our prospective cohort included 2,286 Healthy Aging in Neighborhoods of Diversity across the Life Span study participants who were community-dwelling adults residing in Baltimore, MD. The predictive variables were lifetime opiate and cocaine use, defined as use of opiates or crack/cocaine ≥5 times. Outcomes included prevalent reduced estimated glomerular filtration rate (eGFR; <60 ml/min/1.73 m2 by Chronic Kidney Disease (CKD)-Epidemiology Collaboration), albuminuria (albumin-to-creatinine ratio >30 mg/g, n = 1,652) and rapid kidney function decline (>3 ml/min/1.73 m2 per year over a median of 4.7 years, n = 1,660). RESULTS Participants' mean age was 48 years, 15% reported opiate use, and 22% reported cocaine use. A total of 115 (5.0%) participants had reduced eGFR, 190 (11.5%) had albuminuria and 230 (13.8%) experienced rapid decline in kidney function. In adjusted logistic regression analyses, both substances were associated with greater odds of reduced eGFR (OR 2.71, 95% CI 1.50-4.89 for opiates; OR 1.40, 95% CI 0.87-2.24 for cocaine). Both substances were associated with greater odds of albuminuria (OR 1.20, 95% CI 0.83-1.73 for opiates; OR 1.80, 95% CI 1.29-2.51 for cocaine). Neither substance was associated with the rapid decline of kidney function. CONCLUSIONS Lifetime opiate and cocaine use was associated with prevalent reduced eGFR and albuminuria, yet not with rapid kidney function decline. The use of opiate and cocaine may be an important risk factor for CKD in urban populations.
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Affiliation(s)
- Tessa Novick
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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Peyrière H, Eiden C, Mallaret M, Victorri-Vigneau C. Medical complications of psychoactive substances with abuse risks: Detection and assessment by the network of French addictovigilance centres. Therapie 2016; 71:563-573. [PMID: 27499243 DOI: 10.1016/j.therap.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/06/2016] [Indexed: 12/16/2022]
Abstract
The use of psychoactive substances, whether occasional or regular, can induce a large number of clinical and/or biological complications. These complications may be related to the effects of the active substance itself and/or adulterants, but also to the modalities for use (administrations route, contexts of use). The detection and evaluation of these potentially severe complications are a public health issue. Beyond the assessment of the potential for abuse of and dependence on psychoactive substances, the collection and evaluation of complications related to the use of the substances are one of the roles of addictovigilance centres. In this article, the expertise of the French addictovigilance centres in the detection and assessment of medical complications related to psychoactive substances, adulterants or route of administration of substances is advanced through a few recent examples.
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Affiliation(s)
- Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Michel Mallaret
- Centre d'addictovigilance, centre hospitalier universitaire, 38043 Grenoble, France
| | - Caroline Victorri-Vigneau
- Département de pharmacologie clinique, centre d'addictovigilance, centre hospitalier universitaire, 44093 Nantes, France
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Frequent injection cocaine use increases the risk of renal impairment among hepatitis C and HIV coinfected patients. AIDS 2016; 30:1403-311. [PMID: 26859371 PMCID: PMC4867986 DOI: 10.1097/qad.0000000000001060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text Objective: To examine the association between injection cocaine use, hepatitis C virus (HCV) infection, and chronic renal impairment (CRI). Design: Prospective observational cohort study of HIV–HCV coinfected patients. Methods: Data from 1129 participants in the Canadian Co-Infection Cohort with baseline and follow-up serum creatinine measurements between 2003 and 2014 were analyzed. Prevalent and incident cohorts were created to examine the association between self-reported past, current, and cumulative cocaine use and chronic HCV with CRI. CRI was defined as an estimated glomerular filtration rate below 70 ml/min per 1.73 m2. Multivariate logistic regression was used to calculate odds ratios, and discrete-time proportional-hazards models were used to calculate hazard ratios for cocaine use, in the two respective cohorts, adjusted for HCV RNA and important demographic, HIV disease stage, and comorbidity confounders. Results: Eighty-seven participants (8%) had prevalent CRI. Past injection cocaine use was associated with a two-fold greater risk of prevalent CRI [odds ratio 2.03, 95% confidence interval (CI) 0.96, 4.32]. During follow-up, 126 of 1061 participants (12%) developed incident CRI (31 per 1000 person-years). Compared to nonusers, heavy (≥ 3 days/week) and frequent injection cocaine users (≥75% of follow-up time) experienced more rapid progression to CRI (hazard ratio 2.65, 95% CI 1.35, 5.21; and hazard ratio 1.82, 95% CI 1.07, 3.07, respectively). There was no association between chronic HCV and CRI in either cohort. Conclusion: After accounting for HCV RNA, frequent and cumulative injection cocaine abuse was associated with CRI progression and should be taken into consideration when evaluating impaired renal function in HIV–HCV coinfection.
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Secondary Focal Segmental Glomerulosclerosis: From Podocyte Injury to Glomerulosclerosis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1630365. [PMID: 27088082 PMCID: PMC4819087 DOI: 10.1155/2016/1630365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 03/10/2016] [Indexed: 11/18/2022]
Abstract
Focal segmental glomerulosclerosis (FSGS) is a common cause of proteinuria and nephrotic syndrome leading to end stage renal disease (ESRD). There are two types of FSGS, primary (idiopathic) and secondary forms. Secondary FSGS shows less severe clinical features compared to those of the primary one. However, secondary FSGS has an important clinical significance because a variety of renal diseases progress to ESRD thorough the form of secondary FSGS. The defining feature of FSGS is proteinuria. The key event of FSGS is podocyte injury which is caused by multiple factors. Unanswered questions about how these factors act on podocytes to cause secondary FSGS are various and ill-defined. In this review, we provide brief overview and new insights into FSGS, podocyte injury, and their potential linkage suggesting clues to answer for treatment of the disease.
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Mai HN, Jeong JH, Kim DJ, Chung YH, Shin EJ, Nguyen LTT, Nam Y, Lee YJ, Cho EH, Nah SY, Jang CG, Lei XG, Kim HC. Genetic overexpressing of GPx-1 attenuates cocaine-induced renal toxicity via induction of anti-apoptotic factors. Clin Exp Pharmacol Physiol 2016; 43:428-37. [DOI: 10.1111/1440-1681.12557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 02/01/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Huynh Nhu Mai
- Neuropsychopharmacology and Toxicology Program; College of Pharmacy; Kangwon National University; Chunchon Korea
| | - Ji Hoon Jeong
- Department of Pharmacology; College of Medicine; Chung-Ang University; Seoul Korea
| | - Dae-Joong Kim
- Department of Anatomy and Cell Biology; Medical School; Kangwon National University; Chunchon Korea
| | - Yoon Hee Chung
- Department of Anatomy; College of Medicine; Chung-Ang University; Seoul Korea
| | - Eun-Joo Shin
- Neuropsychopharmacology and Toxicology Program; College of Pharmacy; Kangwon National University; Chunchon Korea
| | - Lan Thuy Ty Nguyen
- Neuropsychopharmacology and Toxicology Program; College of Pharmacy; Kangwon National University; Chunchon Korea
| | - Yunsung Nam
- Neuropsychopharmacology and Toxicology Program; College of Pharmacy; Kangwon National University; Chunchon Korea
| | - Yu Jeung Lee
- Clinical Pharmacy; College of Pharmacy; Kangwon National University; Chunchon Korea
| | - Eun-Hee Cho
- Department of Internal Medicine; Medical School; Kangwon National University; Chunchon Korea
| | - Seung-Yeol Nah
- Ginsentology Research Laboratory and Department of Physiology; College of Veterinary Medicine; Konkuk University; Seoul Korea
| | - Choon-Gon Jang
- Department of Pharmacology; School of Pharmacy; Sungkyunkwan University; Suwon Korea
| | - Xin Gen Lei
- Department of Animal Science; Cornell University; Ithaca New York USA
| | - Hyoung-Chun Kim
- Neuropsychopharmacology and Toxicology Program; College of Pharmacy; Kangwon National University; Chunchon Korea
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Hirachan P, Agarwal R, Wagner B. Cocaine: A Rare Cause of Left-Sided Renal Infarction. J Investig Med High Impact Case Rep 2015; 3:2324709615574907. [PMID: 26425633 PMCID: PMC4586911 DOI: 10.1177/2324709615574907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cocaine abuse is commonly associated with myocardial ischemia, mesenteric ischemia, and cerebrovascular accidents. Renal infarction is an uncommon complication of cocaine abuse. Various mechanisms have been postulated for this cocaine-related injury. There are only 15 cases reported on cocaine-induced renal infarction. Among the cases with available data, very few cases had left kidney involvement. We report a case of a 65-year-old African American man with history of cocaine abuse who presented with left flank pain and had left renal infarction.
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Affiliation(s)
- Padam Hirachan
- Agarwal Nephrology and Hypertension PC, Columbus, GA, USA
| | | | - Brent Wagner
- University of Texas Health Science Center at San Antonio, TX, USA
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36
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Goel N, Pullman JM, Coco M. Cocaine and kidney injury: a kaleidoscope of pathology. Clin Kidney J 2014; 7:513-7. [PMID: 25859366 PMCID: PMC4389131 DOI: 10.1093/ckj/sfu092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/13/2014] [Indexed: 12/21/2022] Open
Abstract
Cocaine is abused worldwide as a recreational drug. It is a potent activator of the sympathetic nervous system leading to intense vasoconstriction, endothelial dysfunction, oxidative stress, platelet activation and decrease in prostaglandins E2 and prostacyclin. Cocaine can lead to widespread systemic adverse effects such as stroke, myocardial infarction, arterial dissection, vascular thrombosis and rhabdomyolysis. In human and rat kidneys, cocaine has been associated with glomerular, tubular, vascular and interstitial injury. It is not uncommon to diagnose cocaine-related acute kidney injury (AKI), malignant hypertension and chronic kidney disease. Cocaine abuse can lead to AKI by rhabdomyolysis, vasculitis, infarction, thrombotic microangiopathy and malignant hypertension. It is reported that 50–60% of people who use both cocaine and heroin are at increased risk of HIV, hepatitis and additional risk factors that can cause kidney diseases. While acute interstitial nephritis (AIN) is a known cause of AKI, an association of AIN with cocaine is unusual and seldom reported. We describe a patient with diabetes mellitus, hypertension and chronic hepatitis C, who presented with AKI. Urine toxicology was positive for cocaine and a kidney biopsy was consistent with AIN. Illicit drugs such as cocaine or contaminants may have caused AIN in this case and should be considered in the differential diagnosis of causes of AKI in a patient with substance abuse. We review the many ways that cocaine adversely impacts on kidney function.
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Affiliation(s)
- Narender Goel
- Division of Nephrology and Hospital Medicine , Middletown Medical PC and Orange Regional Medical Center , Middletown, NY , USA ; Division of Nephrology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
| | - James M Pullman
- Division of Pathology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
| | - Maria Coco
- Division of Nephrology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
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Pendergraft WF, Herlitz LC, Thornley-Brown D, Rosner M, Niles JL. Nephrotoxic effects of common and emerging drugs of abuse. Clin J Am Soc Nephrol 2014; 9:1996-2005. [PMID: 25035273 DOI: 10.2215/cjn.00360114] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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 ANCA-associated 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.
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Affiliation(s)
- William F Pendergraft
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Nephrology, Department of Medicine, and Vasculitis and Glomerulonephritis Clinic, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Leal C Herlitz
- Division of Renal Pathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Denyse Thornley-Brown
- Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Mitchell Rosner
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John L Niles
- Division of Nephrology, Department of Medicine, and Vasculitis and Glomerulonephritis Clinic, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts;
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Buettner M, Toennes SW, Buettner S, Bickel M, Allwinn R, Geiger H, Bratzke H, Amann K, Jung O. Nephropathy in illicit drug abusers: a postmortem analysis. Am J Kidney Dis 2014; 63:945-53. [PMID: 24823296 DOI: 10.1053/j.ajkd.2014.01.428] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/17/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Illicit drug abuse is an independent risk factor for chronic kidney disease, but the pathogenic consequences of long-term exposure to illicit drugs and contaminants under unsterile conditions remains unclear. STUDY DESIGN Case series. SETTING & PARTICIPANTS All deceased persons (n 5 129) who underwent forensic autopsy because of suspected connection with illicit drug abuse between January 1, 2009, and April 30, 2011, in Frankfurt/Main, Germany. PREDICTOR Clinical characteristics and patterns of drug abuse. OUTCOMES Histopathologic alterations of the kidney. MEASUREMENTS Hematoxylin and eosin, periodic acid-Schiff, Sirius, and Congo Red stainings and immunoglobulin A immunohistochemistry of all cases; additional histochemical stainings or immunohistochemistry and electron microscopy in selected cases. RESULTS Individuals were mostly white (99.2%), were male (82.2%), and had intravenous drug use (IVDU) (81.4%). Median age at death was 39 years and duration of drug abuse was 17 years. The majority (79.1%) took various drugs in parallel as assessed by toxicologic analysis. Despite a young age, the deceased had a high burden of comorbid conditions, especially cardiovascular disease, liver cirrhosis, and infections. Evaluation of the kidneys demonstrated a broad spectrum of pathologic alterations predominated by arteriosclerotic and ischemic damage, mild interstitial inflammation, calcification of renal parenchyma, and interstitial fibrosis and tubular atrophy, with hypertensive-ischemic nephropathy as the most common cause of nephropathy. Interstitial inflammation (OR, 16.59; 95% CI, 3.91-70.39) and renal calcification (OR, 2.43; 95% CI, 1.03- 5.75) were associated with severe IVDU, whereas hypertensive and ischemic damage were associated with cocaine abuse (OR, 6.00; 95% CI, 1.27-28.44). Neither specific glomerular damage indicative for heroin and hepatitis C virus-related disease nor signs of analgesic nephropathy were found. LIMITATIONS White population, lack of a comparable control group, incomplete clinical data, and absence of routine immunohistochemistry and electron microscopy. CONCLUSIONS Illicit drug abuse is associated with a broad but unspecific spectrum of pathologic alterations of the kidneys. Cocaine abuse has a deleterious role in this setting by promoting hypertensive and ischemic damage.
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Luciano RL, Perazella MA. Nephrotoxic effects of designer drugs: synthetic is not better! Nat Rev Nephrol 2014; 10:314-24. [PMID: 24662435 DOI: 10.1038/nrneph.2014.44] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Designer drugs are synthetic, psychoactive substances with similar structures and activity to existing scheduled drugs or controlled chemical compounds. The use of these drugs is not generally considered illegal and they cannot be detected using standard toxicology tests--essentially they are considered to be 'legal highs'. Over the past several years, increasing numbers of designer drugs have become available. These drugs are classified as amphetamine derivatives, phenylpiperazine derivatives, synthetic cathinones, synthetic cannabinoids, phencyclidine derivatives and synthetic opioids. Although euphoria is the desired effect, neuropsychiatric and cardiac manifestations are frequently observed in individuals using these drugs at high doses or using drugs that are contaminated with other substances. Some designer drugs are also associated with adverse renal effects, including acute kidney injury from pigment nephropathy, acute tubular necrosis, obstructive nephropathy and hyponatraemia. The misuse of these drugs should be recognized and clinicians made aware of the potential for acute nephrotoxicity as the health burden of these compounds increases.
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Affiliation(s)
- Randy L Luciano
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT 06520-8029, USA
| | - Mark A Perazella
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT 06520-8029, USA
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Abstract
Illicit drug use is prevalent worldwide; over 24 million people are estimated to have used recreational drugs during the past month in the UK and USA alone. Illicit drug use can result in a wide spectrum of potential medical complications that include many urological manifestations. To ensure optimal care and treatment, urologists need to be cognizant of these complications in their patients, particularly among youths. Ketamine uropathy is thought to affect over one-quarter of ketamine users and can lead to severe lower urinary tract symptoms, as well as upper tract obstruction. Cannabis use has been associated with an increased risk of bladder cancer, prostate cancer and nonseminomatous germ cell tumours in case-control studies. Fournier's gangrene has been reported following injection of heroin and cocaine into the penis. Excessive use of cough medicines can lead to the development of radiolucent stones composed of ephedrine, pseudoephedrine and guaifenesin. As the current evidence is mostly limited to case reports and case series, future epidemiological studies are needed to fully address this issue.
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Affiliation(s)
- Sean C Skeldon
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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Álvarez Díaz H, Marińo Callejo AI, García Rodríguez JF, Rodríguez Pazos L, Gómez Buela I, Bermejo Barrera AM. ANCA-positive vasculitis induced by levamisole-adulterated cocaine and nephrotic syndrome: The kidney as an unusual target. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:557-61. [PMID: 24478818 PMCID: PMC3905810 DOI: 10.12659/ajcr.889731] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 09/29/2013] [Indexed: 11/09/2022]
Abstract
Patient: Male, 36 Final Diagnosis: Levamisole-induced vasculopathy Symptoms: Purpuric skin lesions Medication: Levamisole Clinical Procedure: — Specialty: Internal Medicine
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Affiliation(s)
- Hortensia Álvarez Díaz
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Ferrol, Health Area of Ferrol, SERGAS, A Coruña, Spain
| | - Ana Isabel Marińo Callejo
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Ferrol, Health Area of Ferrol, SERGAS, A Coruña, Spain
| | - José Francisco García Rodríguez
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Ferrol, Health Area of Ferrol, SERGAS, A Coruña, Spain
| | - Laura Rodríguez Pazos
- Department of Dermatology, University Hospital of Ferrol, Health Area of Ferrol, SERGAS, A Coruña, Spain
| | - Inmaculada Gómez Buela
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Ferrol, Health Area of Ferrol, SERGAS, A Coruña, Spain
| | - Ana María Bermejo Barrera
- Institute of Forensic Science "Luís Concheiro", Forensic Toxicology Services, Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
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Edwards BJ, Usmani S, Raisch DW, McKoy JM, Samaras AT, Belknap SM, Trifilio SM, Hahr A, Bunta AD, Abu-Alfa A, Langman CB, Rosen ST, West DP. Acute kidney injury and bisphosphonate use in cancer: a report from the research on adverse drug events and reports (RADAR) project. J Oncol Pract 2013; 9:101-6. [PMID: 23814519 DOI: 10.1200/jop.2011.000486] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To determine whether acute kidney injury (AKI) is identified within the US Food and Drug Administration's Adverse Events and Reporting System (FDA AERS) as an adverse event resulting from bisphosphonate (BP) use in cancer therapy. METHODS A search of the FDA AERS records from January 1998 through June 2009 was performed; search terms were "renal problems" and all drug names for BPs. The search resulted in 2,091 reports. We analyzed for signals of disproportional association by calculating the proportional reporting ratio for zoledronic acid (ZOL) and pamidronate. Literature review of BP-associated renal injury within the cancer setting was conducted. RESULTS Four hundred eighty cases of BP-associated acute kidney injury (AKI) were identified in patients with cancer. Two hundred ninety-eight patients (56%) were female; mean age was 66 ± 10 years. Multiple myeloma (n = 220, 46%), breast cancer (n = 98, 20%), and prostate cancer (n = 24, 5%) were identified. Agents included ZOL (n = 411, 87.5%), pamidronate (n = 8, 17%), and alendronate (n = 36, 2%). Outcomes included hospitalization (n = 304, 63.3%) and death (n = 68, 14%). The proportional reporting ratio for ZOL was 1.22 (95% CI, 1.13 to 1.32) and for pamidronate was 1.55 (95% CI, 1.25 to 1.65), reflecting a nonsignificant safety signal for both drugs. CONCLUSION AKI was identified in BP cancer clinical trials, although a safety signal for BPs and AKI within the FDA AERS was not detected. Our findings may be attributed, in part, to clinicians who believe that AKI occurs infrequently; ascribe the AKI to underlying premorbid disease, therapy, or cancer progression; or consider that AKI is a known adverse drug reaction of BPs and thus under-report AKI to the AERS.
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Affiliation(s)
- Beatrice J Edwards
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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43
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Lucas GM, Jing Y, Sulkowski M, Abraham AG, Estrella MM, Atta MG, Fine DM, Klein MB, Silverberg MJ, Gill MJ, Moore RD, Gebo KA, Sterling TR, Butt AA. Hepatitis C viremia and the risk of chronic kidney disease in HIV-infected individuals. J Infect Dis 2013; 208:1240-9. [PMID: 23904290 DOI: 10.1093/infdis/jit373] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The role of active hepatitis C virus (HCV) replication in chronic kidney disease (CKD) risk has not been clarified. METHODS We compared CKD incidence in a large cohort of HIV-infected subjects who were HCV seronegative, HCV viremic (detectable HCV RNA), or HCV aviremic (HCV seropositive, undetectable HCV RNA). Stages 3 and 5 CKD were defined according to standard criteria. Progressive CKD was defined as a sustained 25% glomerular filtration rate (GFR) decrease from baseline to a GFR < 60 mL/min/1.73 m2. We used Cox models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A total of 52 602 HCV seronegative, 9508 HCV viremic, and 913 HCV aviremic subjects were included. Compared with HCV seronegative subjects, HCV viremic subjects were at increased risk for stage 3 CKD (adjusted HR 1.36 [95% CI, 1.26, 1.46]), stage 5 CKD (1.95 [1.64, 2.31]), and progressive CKD (1.31 [1.19, 1.44]), while HCV aviremic subjects were also at increased risk for stage 3 CKD (1.19 [0.98, 1.45]), stage 5 CKD (1.69 [1.07, 2.65]), and progressive CKD (1.31 [1.02, 1.68]). CONCLUSIONS Compared with HIV-infected subjects who were HCV seronegative, both HCV viremic and HCV aviremic individuals were at increased risk for moderate and advanced CKD.
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44
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Singh VP, Singh N, Jaggi AS. A review on renal toxicity profile of common abusive drugs. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2013; 17:347-57. [PMID: 23946695 PMCID: PMC3741492 DOI: 10.4196/kjpp.2013.17.4.347] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/25/2013] [Accepted: 07/14/2013] [Indexed: 12/22/2022]
Abstract
Drug abuse has become a major social problem of the modern world and majority of these abusive drugs or their metabolites are excreted through the kidneys and, thus, the renal complications of these drugs are very common. Morphine, heroin, cocaine, nicotine and alcohol are the most commonly abused drugs, and their use is associated with various types of renal toxicity. The renal complications include a wide range of glomerular, interstitial and vascular diseases leading to acute or chronic renal failure. The present review discusses the renal toxicity profile and possible mechanisms of commonly abused drugs including morphine, heroin, cocaine, nicotine, caffeine and alcohol.
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Affiliation(s)
- Varun Parkash Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala-147002, India
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45
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Alfaro R, Vasavada N, Paueksakon P, Hernandez GT, Aronoff GR. Cocaine-induced acute interstitial nephritis: A case report and review of the literature. J Nephropathol 2013; 2:204-9. [PMID: 24475451 DOI: 10.12860/jnp.2013.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/02/2013] [Accepted: 01/28/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute tubular necrosis and pigment induced kidney injury are well described consequences of cocaine abuse. However, acute interstitial nephritis associated with cocaine use has been previously reported in only three patients. CASE PRESENTATION We present the case of a 49-year-old man who developed acute kidney injury from biopsy-proven interstitial nephritis after nasal insufflation of cocaine. Unlike prior reports, our patient remained non-oliguric and did not require renal replacement therapy. CONCLUSIONS Interstitial nephritis should be considered as a potential cause of acute kidney injury associated with cocaine use. The approach to management of cocaine associated acute kidney injury (AKI) may be different in patients with interstitial nephritis than for those with tubular necrosis or pigment induced renal injury.
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Affiliation(s)
- Rodrigo Alfaro
- Division of Nephrology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nina Vasavada
- Division of Nephrology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Paisit Paueksakon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - German T Hernandez
- Division of Nephrology & Hypertension, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - George R Aronoff
- Division of Nephrology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
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46
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Garcia-Garcia G, Gutiérrez-Padilla AJ, Renoirte-Lopez K, Mendoza-Garcia M, Oseguera-Vizcaino MC, Perez-Gomez HR, Marquez-Amezcua JM, Tonelli M. Chronic kidney disease in homeless persons in Mexico. Kidney Int Suppl (2011) 2013; 3:250-253. [PMID: 25018992 PMCID: PMC4089649 DOI: 10.1038/kisup.2013.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Little is known about the prevalence of chronic kidney disease (CKD) among the homeless in Mexico. The role of substance abuse, alcoholism, and homelessness in CKD has not been properly evaluated. We screened 260 homeless individuals in the state of Jalisco, Mexico, for the presence of CKD and its risk factors, and compared their characteristics with those from a separate cohort of poor Jalisco residents and with a survey of the general Mexican population. CKD was more prevalent among the homeless than among the poor Jalisco population (22% vs. 15.8%, P=0.0001); 16.5% had stage 3, 4.3% stage 4, and 1.2% stage 5. All were unaware of having CKD. Only 5.8% knew they had diabetes, but 19% had fasting blood sugar >126 mg/dl; 3.5% knew they were hypertensive but 31% had systolic blood pressure ⩾140 mm Hg or diastolic blood pressure ⩾90 mm Hg. Alcoholism was less common than in the poor Jalisco population (23.5% vs. 32.3%, P=0.002), but tobacco smoking (34.6% vs. 21.5%, P=0.0001) and substance abuse (18% vs. 1.1%, P=0.0001) were more prevalent among the homeless. Likewise, chronic viral infections such as HIV (4.5% vs. 0.3%, P=0.0001) and HCV (7.7% vs. 1.4%, P=0.0001) were also significantly higher among the homeless than in the general population. In conclusion, CKD and its risk factors are highly prevalent among the homeless individuals in Jalisco, Mexico. Lack of awareness of having diabetes and hypertension is highly common, as is substance abuse. Programs aiming to prevent CKD and its risk factors in Mexico should specifically target this high-risk population.
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Affiliation(s)
- Guillermo Garcia-Garcia
- Hospital Civil de Guadalajara, Division of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | | | - Karina Renoirte-Lopez
- Hospital Civil de Guadalajara, Division of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | | | - Ma C Oseguera-Vizcaino
- Hospital Civil de Guadalajara, Division of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Hector R Perez-Gomez
- Hospital Civil de Guadalajara, Division of Nephrology, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | | | - Marcello Tonelli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Luo FC, Zhao L, Deng J, Liang M, Zeng XS, Liu H, Bai J. Geranylgeranylacetone protects against morphine-induced hepatic and renal damage in mice. Mol Med Rep 2012; 7:694-700. [PMID: 23229517 DOI: 10.3892/mmr.2012.1217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/21/2012] [Indexed: 11/06/2022] Open
Abstract
The acute or chronic administration of opioid drugs may induce oxidative damage and cellular apoptosis in the liver and kidney, and hence result in hepatic and renal damage. Thioredoxin-1 (Trx-1) and heat shock protein 70 (Hsp70) are emerging as important modulators of cellular functions. They have been shown to be involved in cellular protective mechanisms against a variety of toxic stressors. The present study was designed to investigate the effects of geranylgeranylacetone (GGA), a pharmacological inducer of Trx-1 and Hsp70, on morphine-induced hepatic and renal damage. Morphine induced apoptosis in the liver and kidney through the mitochondria-mediated apoptosis pathway, but not the endoplasmic reticulum-mediated pathway. The activation of caspases-9 and -3 was attenuated by pre‑treatment with GGA. In addition, the morphine-induced increase of malondialdehyde (MDA) levels was suppressed by GGA. Furthermore, GGA enhanced morphine-induced expression of Trx-1 and Hsp70 in the liver and kidney. The findings of this study suggest that GGA may be a safe and novel therapeutic agent for morphine‑induced hepatic and renal damage.
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Affiliation(s)
- Fu-Cheng Luo
- Medical Faculty, Kunming University of Science and Technology, Kunming 650500, P.R. China
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48
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Akkina SK, Ricardo AC, Patel A, Das A, Bazzano LA, Brecklin C, Fischer MJ, Lash JP. Illicit drug use, hypertension, and chronic kidney disease in the US adult population. Transl Res 2012; 160:391-8. [PMID: 22735028 PMCID: PMC3461092 DOI: 10.1016/j.trsl.2012.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 05/24/2012] [Accepted: 05/25/2012] [Indexed: 11/19/2022]
Abstract
Illicit drug use has been associated with chronic kidney disease (CKD) in select populations, but it is unknown whether the same association exists in the general population. By using data from the National Health and Nutrition Examination Survey 2005-2008, we conducted a cross-sectional analysis of 5861 adults who were questioned about illicit drug use, including cocaine, methamphetamines, and heroin, during their lifetime. The primary outcome was CKD as defined by an estimated glomerular filtration rate ≤60 mL/min/1.73 m(2) using the Chronic Kidney Disease Epidemiology Collaboration equation or by microalbuminuria. We also examined the association between illicit drug use and blood pressure (BP) ≥120/80, ≥130/85, and ≥140/90 mm Hg. Logistic regression was used to examine the association between illicit drug use and CKD and BP. Mean estimated glomerular filtration rate was similar between illicit drug users and nonusers (100.7 vs 101.4 mL/min/1.73 m(2), P = 0.4), as was albuminuria (5.7 vs 6.0 mg/g creatinine, P = 0.5). Accordingly, illicit drug use was not significantly associated with CKD in logistic regression models (odds ratio [OR], 0.98; confidence interval [CI], 0.75-1.27) after adjusting for other important factors. However, illicit drug users had higher systolic (120 vs 118 mm Hg, P = 0.04) and diastolic BP (73 vs 71 mm Hg, P = 0.0003) compared with nonusers. Cocaine use was independently associated with BP ≥130/85 mm Hg (OR, 1.24; CI, 1.00-1.54), especially when used more during a lifetime (6-49 times; OR, 1.42; CI, 1.06-1.91). In a representative sample of the US population, illicit drug use was not associated with CKD, but cocaine users were more likely to have elevated BP.
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Affiliation(s)
- Sanjeev K Akkina
- Medicine/Nephrology, University of Illinois at Chicago, Chicago, IL 60612-7315, USA.
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49
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Jung O, Haack HS, Buettner M, Betz C, Stephan C, Gruetzmacher P, Amann K, Bickel M. Renal AA-amyloidosis in intravenous drug users--a role for HIV-infection? BMC Nephrol 2012; 13:151. [PMID: 23171281 PMCID: PMC3519698 DOI: 10.1186/1471-2369-13-151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/18/2012] [Indexed: 11/12/2022] Open
Abstract
Background Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades. Methods Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany. Results Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1–2 years. Conclusions AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU.
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Affiliation(s)
- Oliver Jung
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany
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50
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Hepatitis C virus viremia increases the incidence of chronic kidney disease in HIV-infected patients. AIDS 2012; 26:1917-26. [PMID: 22781222 DOI: 10.1097/qad.0b013e3283574e71] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several studies have reported on an association between hepatitis C virus (HCV) antibody status and the development of chronic kidney disease (CKD), but the role of HCV viremia and genotype are not well defined. METHODS Patients with at least three serum creatinine measurements after 1 January 2004 and known HCV antibody status were included. Baseline was defined as the first eligible estimated glomerular filtration rate (eGFR) (Cockcroft-Gault equation), and CKD was either a confirmed (>3 months apart) eGFR of 60 ml/min per 1.73 m or less for patients with a baseline eGFR more than 60 ml/min per 1.73 m or a confirmed 25% decline in eGFR for patients with a baseline eGFR of 60 ml/min per 1.73 m or less. Incidence rates of CKD were compared between HCV groups (anti-HCV-negative, anti-HCV-positive with or without viremia) using Poisson regression. RESULTS Of 8235 patients with known anti-HCV status, 2052 (24.9%) were anti-HCV-positive of whom 983 (47.9%) were HCV-RNA-positive, 193 (9.4%) HCV-RNA-negative and 876 (42.7%) had unknown HCV-RNA. At baseline, the median eGFR was 97.6 (interquartile range 83.8-113.0) ml/min per 1.73 m. During 36123 person-years of follow-up (PYFU), 495 patients progressed to CKD (6.0%) with an incidence rate of 14.5 per 1000 PYFU (95% confidence interval 12.5-14.9). In a multivariate Poisson model, patients who were anti-HCV-positive with HCV viremia had a higher incidence rate of CKD, whereas patients with cleared HCV infection had a similar incidence rate of CKD compared with anti-HCV-negative patients. There was no association between CKD and HCV genotype. CONCLUSION Compared with HIV-monoinfected patients, HIV-positive patients with chronic rather than cleared HCV infection were at increased risk of developing CKD, suggesting a contribution from active HCV infection toward the pathogenesis of CKD.
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