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Kidney Week

Abstract: TH-PO068

Cocaine-Associated Acute Tubular Injury and Acute Interstitial Nephritis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Arya P V, Akhila, Bridgeport Hospital Internal Medicine, Bridgeport, Connecticut, United States
  • Tan, Jia Wei, Bridgeport Hospital Internal Medicine, Bridgeport, Connecticut, United States
Introduction

Cocaine can affect various compartments of the nephron, leading to conditions such as rhabdomyolysis-induced acute kidney injury (AKI) and rarely, cocaine-associated acute interstitial nephritis (AIN). In our case, the patient presented with AIN and acute tubular injury (ATI) without
rhabdomyolysis.

Case Description

A previously healthy 37-year-old male presented with left flank and epigastric pain for three days. He denied taking any medication or recreational drugs. On admission, his blood pressure was 147/84 mmHg. He appeared euvolemic and had no rashes, purpuras, or arthralgias.
Labs showed serum creatinine of 10.7 mg/dL without a prior baseline, blood urea nitrogen of 58 mg/dL, bicarbonate of 19 mmol/L, anion gap of 23, phosphorous of 9.6 mg/dL and creatinine kinase of 66 international units. Urinalysis showed 1+ proteinuria, 1 RBC/hpf, and 1 WBC/hpf. His protein/creatinine ratio was 0.57 mg/mg Cr. C3 and C4 were normal. Hepatitis B, C, and HIV were negative. ANA was negative, and the ANA was 1:40 in a perinuclear pattern. Renal ultrasound showed normal-sized kidneys and CT abdomen did not reveal any pathological findings. A renal biopsy confirmed the presence of diffuse AIN and ATI (Image 1, H& E, 40x). The patient’s kidney function gradually improved without steroid treatment and a follow-up outpatient visit showed serum creatinine of 1.67 mg/dL.

Discussion

We highlight the importance of considering cocaine-associated renal complications, even in the absence of rhabdomyolysis, and highlight the rare presentation of concomitant ATI and AIN. The clinical, biochemical and urinalysis of AIN can be subtle and non-specific, making it challenging to diagnose. However, if there is a strong clinical suspicion of AIN, renal biopsy should be pursued to allow early recognition and potential treatment. Our patient’s renal function recovered with supportive management alone, but further data are needed to fully understand the clinical course and treatment strategies for cocaine-associated AIN and ATI.

Light microscopy showing patchy diffuse acute interstitial nephritis and focal acute tubular injury