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Abstract: PO0137

Renal Abnormalities in Patients with e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Abraham, Josephine, University of Utah Hospital, Salt Lake City, Utah, United States
  • Stonhill, Miekan A., University of Utah Hospital, Salt Lake City, Utah, United States
  • Gregory, Martin C., University of Utah Hospital, Salt Lake City, Utah, United States
  • Callahan, Sean J., University of Utah Hospital, Salt Lake City, Utah, United States
Background

The use of electronic cigarettes is linked to the development of lung injury. There are no reports to date of renal injury secondary to vaping. Animal studies suggest that vaping could be associated with renal injury (1,2).

Methods

A retrospective chart review of the first twenty cases of patients with EVALI was performed. We present the urinary abnormalities noted in patients with EVALI.

Results

Twenty patients admitted for EVALI underwent urinalysis as part of their laboratory workup. None of these patients had known pre-existing renal disease. All patients except for one had normal creatinine on admission. Proteinuria was seen in thirteen patients (65%) and microscopic hematuria (>4 RBC/hpf) was seen in five patients (20%). All patients with microscopic hematuria also had proteinuria.

Conclusion

EVALI can be associated with hematuria and proteinuria. In animal studies, E cigarette vapor is hypothesized to diminish airway barrier function, release inflammatory protein into the circulation creating systemic inflammation leading to distant organ injury and dysfunction (2).
There are several limitations to this study. This is a retrospective chart review and long term outcome is unknown as data is lacking. Nevertheless the high prevalence of urinary abnormalities on admission in patient with EVALI calls for further investigation. While the pathogenesis of vaping-associated renal injury is unclear, urine analysis should be considered in all patients presenting with EVALI.

Ref
1. Impact of e cigarette refill liquid exposure on rat kidney Golli NE et al. Regul Toxicol Pharmacol 2016 Jun;77:109-16
2. Chronic inhalation of e-cigarette vapor containing nicotine disrupts airway barrier function and induces inflammation and multiorgan fibrosis in mice Crotty Alexander et al Am J Physiol Regul Integr Comp Physiol. 2018 Jun 1;314(6):R834-R847

Urinary abnormalities in 20 patients with EVALI
PROTEINURIA1365%
1+proteinuria(30mg/dL)840%
2+proteinuria(100mg/dL)420%
3+proteinuria(>500mg/dL)15%
HEMATURIA525%
Hematuria and 1+proteinuria420%
Hematuria and 3+proteinuria15%