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Kidney Week

Abstract: TH-PO128

Sizzurp Joins the List: AKI from Recreational Drug Use

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Sales, Cecille Marie Cueto, Rush University Medical Center, Chicago, Illinois, United States
  • Migally, Farida, Nephrology Associates of Northern Illinois and Indiana, Chicago, Illinois, United States
  • Rodby, Roger A., Rush University Medical Center, Chicago, Illinois, United States
Introduction

Synthetic cannabinoids and bath salts, both popular for their psychoactive effects have been associated with acute kidney injury (AKI). Another recreational drug “sizzurp” (also known as “purple drank”, and “lean”) was first used in the 1960s and made popular in the 1990s by the hip hop community. It consists of the antihistamine promethazine +/- codeine, typically mixed with a sweet soft drink, and ingested in higher than prescribed doses. Promethazine causes CNS depression, cholestatic jaundice and hypotension. Codeine can cause behavioral changes, respiratory depression, and cardiac arrest. Promethazine induces codeine metabolism to morphine via CYP2D6, potentiating a “high” and intensifying the sedative effects. Sizzurp is desired for creating euphoria accompanied by a “dissociative feeling”. Often ingested with alcohol, its risk profile is magnified.

Case Description

We have a 39-y/o man with no PMH, who presented with abdominal pain after taking sizzurp for several days. He had scleral icterus and a BP of 150/96. Labs: WBC 25.4, Hgb 13.2 g/dl, Plt 367k, BUN 80 mg/dl, Cr 8.3 mg/dl. Total bilirubin was 12 mg/dl with a mild transaminitis and a CK of 1500 units/L. The UA showed mild hematuria and proteinuria with urine P/C ratio of 1.2 g/g. The urine drug screen was positive for cannabinoids. Serologies, SPEP and UPEP were negative. The kidneys were normal in size and echogenicity and without hydronephrosis. Liver US showed fatty infiltration and liver biopsy revealed drug induced injury. A renal biopsy had 11 nl glomeruli with diffuse ATN, focal interstitial nephritis and a negative bile stain. IF was negative. He was oliguric and required dialysis for one month but had eventual renal recovery with a Cr of 1.3 mg/dl.

Discussion

Little is known about the mechanism of AKI in many recreational street drugs including sizzurp. It may be directly toxic (nephrotoxic ATN) or it may be associated with hypoperfusion leading to ischemic ATN. Sizzurp should be added to the list of recreational drugs associated with AKI.

Figure 1. ATN with focal interstitial nephritis.