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Kidney Week

Abstract: TH-PO548

Something Amiss with Cannabis: AKI Associated with Cannabidiol Ingestion

Session Information

  • Trainee Case Reports - I
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 103 AKI: Mechanisms

Authors

  • Yen, Timothy E., Methodist Dallas Medical Center, Dallas, Texas, United States
  • Aponte, Armando, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Chekuri, Lakshmi, Methodist Richardson Medical Center, Plano, Texas, United States
  • Lytvak, Irina, Methodist Richardson Medical Center, Plano, Texas, United States
  • Zhou, Xin J., Renal Path Diagnostics, Lewisville, Texas, United States
  • Mohmand, Hashim K., Dallas Nephrology Associates, Dallas, Texas, United States
Introduction

Cannabidiol (CBD) is a nonpsychoactive phytocannabinoid that is a popular dietary supplement with proposed medicinal properties. Although synthetic cannabinoids (SCs) such as K2/Spice have been implicated in kidney injury in over 20 case reports, CBD's renal effects are not as well documented.

Case Description

A 58 year old female with diabetes, hypertension and two weeks of abdominal pain and diarrhea presented with one day of emesis, anuria and CT imaging concerning for mild colitis. Medications were omeprazole, losartan, carvedilol, metformin and Insulin. She had started ingesting commercial, hemp-derived CBD Oil three months earlier but denied drug use, including Spice, K2 or marijuana. She had tachycardia and mild abdominal tenderness on physical examination. Initial lab tests showed renal failure, with a serum Cr 7.1 mg/dL (baseline 1.0), BUN 49 mg/dL, and potassium 7.1 mmol/L.

The patient received emergent hemodialysis for refractory hyperkalemia. Urine output improved and gastrointestinal symptoms resolved in 24 hours. Urinalysis was negative for casts but urine protein/Cr and microalbumin/Cr ratios were 15 g/g and 4.4 g/g, respectively. Autoimmune and viral workups were unremarkable, as were SPEP, UPEP and free light chain assay. Renal biopsy showed extensive isometric cytoplasmic vacuolization of tubular cells. Under electron microscopy, these vacuoles were seen to be membrane-bound and corresponded to dilated endoplasmic reticulum. This disease pattern suggested toxic tubular injury and occurred on a background of diabetic glomerulosclerosis with mild TA/IF. Urine studies demonstrated evidence of a proximal tubulopathy with elevated 24h fractional excretion of phosphorous (68.4%) and Uric Acid (7.8%).

The patient’s renal function improved over the next week and she was discharged with a Cr of 3.1 mg/dL. Five weeks after discharge, her serum Cr and proteinuria had improved to 1.4mg/dL and 215 mg/g, respectively.

Discussion

The mechanism for SC-associated kidney injury is unknown but tubular vacuolization has been documented in several cases. Although CBD differs from SCs in that it has little activity on the Cannabinoid 1 and 2 receptors, it has >65 molecular targets and could share a common mechanism for renal injury. This is the first reported case of renal injury associated with CBD use.