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Kidney Week

Abstract: PO0317

Acute Interstitial Nephritis Secondary to Cocaine Use

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Broka, Andrea, SBH Health System, Bronx, New York, United States
  • Flores chang, Marjorie Mailing, SBH Health System, Bronx, New York, United States
  • Arias Morales, Carlos Ernesto, SBH Health System, Bronx, New York, United States
  • Abdurham, Ahmed, SBH Health System, Bronx, New York, United States
  • Ibrahim, Jamil, SBH Health System, Bronx, New York, United States
  • Flores Chang, Bessy Suyin, SBH Health System, Bronx, New York, United States
Introduction

Renal failure resulting from cocaine use disorder is well documented with etiology ranging from rhabdomyolysis, vasculitis, thrombotic microangiopathy and rarely acute interstitial nephritis, although unclear underlying mechanisms

Case Description

33-year-old African American female with history of bipolar disorder alcohol, crack, cocaine use disorder presented with generalized fatigue and dyspnea for the past 4 days requesting inpatient detox. Home medications were ziprasidone, trazadone, topiramate. No recent history of nonsteroidal anti-inflammatory drugs, antacids or antibiotics. Family history was positive for hypertension only. On exam, vitally stable but, she was lethargic, with fluctuating sensorium and attention, with painful, deep linear nonbleeding lesion on oral mucosa and oliguric. Rest of exam was unremarkable.
Her initial work up showed elevated blood urea nitrogen (BUN) 215 mg/dL and serum creatinine (SCr) 19.3 mg/dL, serum bicarbonate of 14 mEq/L, leukocytosis 19.2 x103 cells/uL with neutrophilia, normal eosinophil count and elevation of liver enzymes. Creatine phosphokinase was 782, peaked at 2574 and down trending the next day. Urinalysis showed large blood with more than 182 red blood cells/ HPF, 27 white blood cells/HPF, and moderate leukocyte esterase. Protein to creatinine ratio 1.12. Urine drug screen was positive for cocaine. Ultrasound kidney was unremarkable. A panel for autoimmune disease, hepatitis, and human immunodeficiency virus was negative.
Initial assessment was acute kidney failure, likely acute tubular necrosis in the setting of cocaine use. She underwent emergent hemodialysis (HD) with improvement on her mental status.
Renal biopsy showed diffuse acute tubulointerstitial nephritis, acute tubular injury, focal myoglobin casts and arteriosclerosis with negative immunofluorescence.
She was started on IV methylprednisolone 1 g/daily for 3 days and then switched to oral prednisone 1 mg/kg for 8 weeks. HD was discontinued, urine output improved, with complete renal recovery on outpatient follow up

Discussion

We believe that AIN must be in the differential when treating patient with AKI and recent cocaine use, treatment must be started as earlier as possible to prevent progression to chronic kidney disease with fibrosis