Abstract: FR-PO028
A Friend on Marijuana Is a Friend in Need: A Report of Acute Interstitial Nephritis (AIN) after Marijuana Use
Session Information
- Fellows/Residents Case Reports: AKI and Drug-Related Interactions
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Robles-Franceschini, Mario J., Methodist Dallas Medical Center, Dallas, Texas, United States
- Strauss, Michael M., Methodist Dallas Medical Center, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Background
Acute kidney injury from synthetic Marijuana use has been reported, but until now no reports are available involving the non-synthetic variety. This is a rare case of Acute Interstitial Nephritis caused by non-synthetic Marijuana smoking.
Methods
A 20 y/o AA man with PMH of asthma, presents to the ER complaining of excruciating bilateral flank pain with associated nausea for 1 day prior to admission. His only medication was PRN albuterol inhaler. He denied OTC drugs or NSAIDS use. Three days prior to the symptoms, he smoked marijuana, but denied other illicit drugs. Physical examination was remarkable for obesity (BMI 37), hypertension 168/92mmhg and unilateral subconjunctival hemorrhage. On admission his creatinine was 1.75 mg/dL, urinalysis revealed protein 300mg/dl, RBCs 10-20/HPF, WBC’s 0-5 /HPF, with no casts or eosinophils. Urine toxicology was positive for tetrahydrocannabinol. Serology studies were normal, including ANA panel, anti GBM, ANCA, ASO titers, HIV ,Hepatitis B/C complements, ESR, IgG 4, SSA/B/ and ACE levels. His renal ultrasound with Doppler was normal. An abdominal CT scan showed perinephric stranding surrounding both kidneys with no stones. Initial management included blood pressure control, volume expansion and he was started empirically on IV steroids due to active sediment and worsening creatinine that peaked at 5mg/dL. Kidney biopsy was performed and showed AIN with marked interstitial lymphocytic infiltrate with eosinophils, interstitial and tubular edema, with normal glomeruli. His kidney function improved with steroids and he was discharged with a creatinine of 2.1 mg/dL.
Conclusion
Acute interstitial Nephritis from smoking non-synthetic marijuana has not been reported. The presentation of this young man with hypertension, active sediment, worsening renal function suggested possibility of Rapidly Progressive Glomerulonephritis and it prompted early treatment with steroids. The finding of AIN on the renal biopsy was crucial in establishing the association to the use of marijuana. It is important to consider AIN in the differential diagnosis of marijuana users that present with AKI, particularly in light of its increasing legalization.