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Kidney Week

Abstract: PO0180

Acute Interstitial Nephritis and Diffuse Pulmonary Infiltrates in Recreational Drug User

Session Information

  • AKI Mechanisms - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Cruz Whitley, Jessica, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Yu, Samuel Mon-Wei, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Cheung, Pui Susan Wen, Massachusetts General Hospital, Boston, Massachusetts, United States
Introduction

Synthetic cannabinoids are designer drugs smoked as an alternative to marijuana with lower cost and greater potency. Here we describe a patient who presented with acute kidney injury and diffuse pulmonary infiltrates with recent inhaled synthetic cannabinoids use.

Case Description

A 26-year-old man with history of alcohol and recreational drug abuse including marijuana, tobacco and vaping, presented with acute kidney injury and diffuse pulmonary infiltrates. He recalled attending a party a week ago where he smoked someone else’s marijuana. On presentation, he was hypertensive to 170/115 mmHg with benign physical examination. Laboratory values were significant for serum creatinine of 17 mg/dL and BUN of 162 mg/dL. Urine sediment showed no cellular casts, but some monomorphic red blood cells, rare dysmorphic red blood cells and white blood cells. He had a spot protein/creatinine ratio of 230 mg/g, Chest X-ray showed bilateral pulmonary infiltrates. Renal ultrasound showed normal kidneys. Laboratory studies were all negative including CK, ANCA, anti-GBM, ANA, dsDNA, SPEP and legionella urinary antigen. His urine toxicology screen was positive for opiates and cannabinoids. Renal biopsy revealed widespread edema of the interstitium and a mild to focally moderate inflammatory infiltrate involving approximately 80% of the cortical area. Tubular dilation, cytoplasmic vacuolization, and rare mitoses were seen in the tubules. He required 2 sessions of hemodialysis, but he had a rapid resolution of his kidney failure with steroid initiation. A repeat chest CT showed resolution of bibasilar opacities, although with persistent upper lobe ground glass opacities consistent with smoking and vaping-related injury.

Discussion

Synthetic cannabinoids use should be considered in young healthy patients who present with unexplained AKI, as there are more case reports suggesting its direct nephrotoxicity. The etiology of tubulointerstitial injury from synthetic cannabinoids remains elusive, but a dysregulation of the endocannabinoid system in kidneys via endogenous cannabinoid receptors, CB1 and CB2, may be part of the mechanisms of injury. The cannabinoid receptors are now recognized to play potential roles in diabetic nephropathy and chronic kidney disease progression, and our case highlights the need of future research on their possible role in immunue activation.