heroin and Acute-Kidney-Injury

The most important task of clinical and experimental nephrology is to identify risk factors for progression of renal failure with the ultimate goal to counteract the dramatic increase of patients reaching end-stage renal disease. Recently, cigarette smoking has been recognized to be one of the most important remediable renal risk factors. The adverse renal effects of smoking seem to be independent of the underlying renal disease and the current evidence suggests a near doubling of the rate of progression in smokers vs. non-smokers. Cessation of smoking slows the rate of progression. Besides smoking, alcohol abuse has also been implicated as a renal risk factor. The present article reviews the current knowledge about the adverse renal effects of these legal drugs. Furthermore, the acute and chronic renal complications due to illegal recreational drugs is discussed. The impact of these drugs on the risk to reach end-stage renal failure is difficult to assess, which is mainly due to the fact that it is difficult to perform controlled prospective studies in substance abusers. According to estimates, 5-6% of new patients starting end-stage renal disease therapy may have opiate-use-related renal diseases in the USA--a figure which documents the magnitude of the problem. Thus, in any case of unexplained renal functional impairment substance abuse should be considered by the physician.

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholism; Amphetamines; Anti-Anxiety Agents; Benzodiazepines; Cocaine; Drug-Related Side Effects and Adverse Reactions; Hallucinogens; Heroin; Humans; Illicit Drugs; Kidney; Kidney Diseases; Kidney Failure, Chronic; Male; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nephrotic Syndrome; Odds Ratio; Risk Factors; Smoking; Smoking Cessation; Substance-Related Disorders; Temazepam

Here we present a case of acute renal failure needing dialysis in a heroin addict patient chronically treated with Metadone. This give us the opportunity to review the renal effects of the main drugs of abuse, highlighting the shift occured from the four "old sisters" (Marijuana, Cocaine, Heroin and Amphetamine) to the news synthetic drugs (chiefly Synthetic Cathinones and Cannabinoids), that poses problems due to large diffusion, easy procurement, legal non-regulation and difficult analytical identification, raising medical and forensic questions. From a Nephrological point of view is essential to take great care over the need to diagnose this kind of pathology and to widen the search trying anyway to recognize the substances potentially involved.

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Renal Dialysis; Substance-Related Disorders

The term rhabdomyolysis describes a damage involving striated muscle cells or fibers, often complicated by acute kidney injury. This syndrome can have different causes, but it is generally divided into two main categories: traumatic and non-traumatic rhabdomyolysis. Among medical causes, drugs and abuse substances play a pivotal role, being opioids, alcohol, cocaine and other substances of abuse. Among drugs, the case of statins is certainly the best known. Here we describe a paradigmatic case of a man treated with success and good tolerance for years with rosuvastatin, who developed a severe rhabdomyolysis complicated by AKI needing hemodialysis, after the assumption of two substances of abuse (cocaine and heroin). Emergency physicians need to be aware of this syndrome, since it must be clinically suspected in order to ask the Laboratory for appropriate tests. Given that troponins are now widely accepted as the unique biochemical "gold standard" for diagnosing acute coronary syndromes, CK and myoglobin (the "gold standard" tests for diagnosing rhabdomyolysis) have been erased from admission test panels of the vast majority of emergency departments.

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Male; Middle Aged; Rhabdomyolysis; Rosuvastatin Calcium

While the risk of opioid overdose is widely accepted, the dangers of opioid withdrawal are far less clearly defined. The purpose of this publication is to provide evidence against the erroneous clinical dictum that opioid withdrawal is never life-threatening.. This case report (N = 1) illustrates an unfortunate, common scenario of a man abusing prescription opioids and heroin. His attempt at self-detoxification with buprenorphine-naloxone resulted in life-threatening opioid withdrawal. A detailed account of each day of his withdrawal period was documented by patient and family report and review of all medical records. The patient was contacted three months after hospitalization to verify information and determine progress in treatment and abstinence from drugs and alcohol.. A review of the literature was completed on severe cases of precipitated and spontaneous opioid withdrawal followed by a discussion of the significance as it relates to this case.. Given the widespread use of prescription opioids and opioid maintenance treatment, physicians should be aware of the complications of acute opioid withdrawal and should be equipped to treat these complications.

Topics: Acute Kidney Injury; Administration, Intranasal; Administration, Oral; Administration, Sublingual; Analgesics, Opioid; Buprenorphine, Naloxone Drug Combination; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Intensive Care Units; Male; Opioid-Related Disorders; Oxycodone; Oxymorphone; Prescription Drugs; Rhabdomyolysis; Self Medication; Substance Withdrawal Syndrome; Young Adult

Heroin exposure can cause various complications like seizures, stroke, spongiform encephalopathy, transverse myelopathy, plexopathy, compartment syndrome, rhabdomyolysis and renal failure due to various mechanisms. We report here a young male who smoked heroin for the first time and developed transverse myelitis, rhabdomyolysis and acute kidney injury requiring dialysis. His renal recovery was complete by four weeks, while neurological improvement occurred 8 to 12 weeks later. This case suggests a common pathogenic mechanism of heroin intoxication involving multiple systems of the body.

Topics: Acute Kidney Injury; Adult; Heroin; Humans; Inhalation; Magnetic Resonance Imaging; Male; Myelitis, Transverse; Narcotics; Rhabdomyolysis

Heroin abuse causes various medical and surgical complications. We report a case of heroin-induced severe bilateral compartment syndrome complicated by rhabdomyolysis, acute renal failure and extremely elevated creatinine kinase. A 30-year-old male heroin addict presented to the emergency department of Mount Vernon Hospital, Mount Vernon, New York complaining of severe pain and burning sensation in both legs and feet 1 day after abusing intravenous heroin. He had severe swelling and tenderness of both legs and feet. Laboratory data revealed tremendous elevation of creatine kinase (236,000 IU/L) consistent with rhabdomyolysis. Acute renal failure developed over subsequent days. Treatment consisted of fasciotomy, hyperbaric oxygen therapy (HBO2) and supportive therapy. The condition gradually improved over 4 weeks and the patient did not require dialysis or amputation.

Topics: Acute Kidney Injury; Adult; Compartment Syndromes; Heroin; Humans; Hyperbaric Oxygenation; Male; Rhabdomyolysis

Topics: Acute Kidney Injury; Adult; Central Nervous System Diseases; Drug Overdose; Female; Heroin; Humans; Narcotics; Pregnancy; Pregnancy Complications; Pregnancy Outcome

Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose.. The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings.. Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination.. The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.

Topics: Acute Kidney Injury; Adult; Bone and Bones; Calcinosis; Drug Overdose; Heroin; Heroin Dependence; Humans; Lung Diseases; Male; Narcotics; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Technetium Tc 99m Medronate

Heroin abuse is an increasing problem in Australia. In our hospitals we have noted an apparent increase in drug-related admissions. In this study we aimed to examine the incidence of renal failure due to heroin-related rhabdomyolysis and to determine any predisposing factors to the requirement for dialysis in these patients.. We identified a group of 27 patients who developed renal failure after recent intravenous heroin use. There was a significant rise in the incidence during 1997-1998 compared with the previous seven years (p < 0.05).. Rhabdomyolysis was the likely cause of renal failure in all cases. Eight patients required dialysis for an average of 14 days (range 3-26). Patients who required dialysis had a higher admission creatine kinase (115 x 10(3) U/l (1-316), median (range), versus 9 x 10(3) (0-91 ), p < 0.05 ), a higher admission creatinine (3.8 mg/dl (2.1- 6.7) versus 2.4 (1.4-8.1), p < 0.05 ), a higher peak creatinine kinase (129 x 10(3) U/l (2-316) versus 22 x 10(3) (3-197), p < 0.05), a lower urine output in the initial 24 hours (0.91/24 hrs (0.1-1.5) versus 3.9(1.0-11.1), p < 0.005) and a longer length of hospitalization (37 days (17-112) versus 12 (5-87), p < 0.05). No patient died and all patients had independent renal function at last review. The majority of patients had significant comorbidities. The incidence of serological evidence of exposure to blood-borne viruses was HIV 5% (n = 1), hepatitis B 10% (n = 2) and hepatitis C 74% (n = 17) of patients tested. Pneumonia occurred in 52% (n = 14) and 26% (n = 7) developed respiratory failure requiring intubation. 22% (n = 6) developed a compartment syndrome requiring fasciotomy and 37% (n = 10) had significant residual limb weakness at discharge.. There is an increase in patients admitted with rhabdomyolysis-induced renal failure associated with heroin use in our hospitals. We found a varied approach to an increasing clinical problem and suggest that a consistent investigative and therapeutic approach be introduced. Although renal recovery can be expected, long-term disability may occur due to potential serious complications.

Topics: Acute Kidney Injury; Adult; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Myoglobinuria; Prevalence; Retrospective Studies; Rhabdomyolysis; Substance Abuse, Intravenous

Topics: Acute Kidney Injury; Adolescent; Compartment Syndromes; Drug Overdose; Heroin; Humans; Male; Rhabdomyolysis

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Topics: Acute Disease; Acute Kidney Injury; Adult; Heroin; Humans; Lumbosacral Plexus; Male; Neuritis; Pulmonary Edema; Rhabdomyolysis

Topics: Acute Kidney Injury; Administration, Inhalation; Adult; Heroin; Humans; Male; Rhabdomyolysis

A wide spectrum of acute and chronic neurological syndromes are associated with heroin addiction. We report two cases with acute brachial/lumbar plexus lesions, with details of the clinical findings, diagnostic procedures and therapy. Possible causes are allergic or toxic reactions to heroin or added substances, as well as nerve compression due to local muscle swelling in connection with rhabdomyolysis. The extent of paresis which occurs is also determined by this compression.

Topics: Acute Kidney Injury; Adult; Brachial Plexus; Drug Overdose; Heroin; Heroin Dependence; Humans; Lumbosacral Plexus; Male; Nerve Compression Syndromes; Neurologic Examination; Rhabdomyolysis

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Rhabdomyolysis; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Cocaine; Female; Heroin; Humans; Male; Myoglobinuria; Rhabdomyolysis; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Heroin; Humans; Male; Rhabdomyolysis; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Heroin; Heroin Dependence; Humans; Male

A report is presented on two patients with massive rhabdomyolysis following heroin intoxication. Due to massive muscle edema of the lower legs, both patients needed early fasciotomy to prevent compression syndrome. The two cases followed a different course as regards complications and especially renal insufficiency and disorders of serum calcium and phosphorus regulation. Pathophysiology, prevention and therapy of complications are discussed. As a result of intensive physiotherapy, the long term functional outcome was satisfactory in both cases.

Topics: Acute Kidney Injury; Adolescent; Adult; Female; Heroin; Heroin Dependence; Humans; Leg; Male; Rhabdomyolysis; Tomography, X-Ray Computed; Water-Electrolyte Imbalance

A 24-year-old man who had been a drug addict for years, was admitted to hospital having been unconscious for several hours after injecting an overdose of heroin. He was in acute renal failure with extensive swelling of soft tissues of the right upper leg and right buttock without external signs of injury. The swelling rapidly extended to both right limbs, trunk and external genitalia. The clinical suspicion of rhabdomyolysis was confirmed by a high level of serum myoglobin (1570 mg/ml), and in a gluteus maximus muscle biopsy. The acute renal failure caused by the rhabdomyolysis was reversible after a short period of haemodialysis and, after decompression fasciotomy of the affected muscles, there were no severe sequelae. In view of the good prognosis with early diagnosis an exact clinical examination (observation of soft tissue swelling and dark urine) is of great importance in case of heroin addiction and/or poisoning.

Topics: Acute Kidney Injury; Adult; Edema; Heroin; Heroin Dependence; Humans; Male; Myoglobin; Myoglobinuria

Topics: Acute Kidney Injury; Glomerulosclerosis, Focal Segmental; Heroin; Heroin Dependence; Humans; Kidney Diseases; Nephrotic Syndrome

Topics: Acute Kidney Injury; Adult; Heroin; Humans; Male; Muscular Diseases; Renal Dialysis

Heroin addiction is associated with several severe and occasionally fatal renal complications. Acute renal failure consequent to rhabdomyolysis and myoglobinuria, when treated supportively, carries a good prognosis. Staphylococcal or other bacterial septicemia may in itself prove fatal and is associated with a proliferative immune complex, acute glomerulonephritis, which generally follows the course and prognosis of septicemia. The necrotizing angiitis reported in heroin addicts still is largely undefined. Focal and segmental glomerular sclerosis is the most common pathologic finding in the syndrome of heroin-associated nephropathy (HAN). Typically, HAN presents with massive proteinuria and progresses rapidly to renal failure. Presumptive evidence supports the premise that heroin or its vehicles elicits immunologically mediated renal damage. The antigen still is unidentified. Removing the antigenic challenge by stopping heroin injection apparently interdicts the progression of renal disease. Renal transplantation can be effectively accomplished in patients with HAN without early recurrence if patients discontinue the use of heroin.

Topics: Acute Kidney Injury; Adult; Female; Glomerulonephritis; Heroin; Heroin Dependence; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Myoglobinuria; Polyarteritis Nodosa; Prognosis; Proteinuria; Sepsis; Syndrome; Transplantation, Homologous

Topics: Acute Kidney Injury; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Electrocardiography; Female; Fetal Diseases; Fetus; Heart Diseases; Hepatitis A; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Male; Maternal-Fetal Exchange; Methods; Neurologic Manifestations; Pneumonia, Aspiration; Pregnancy; Pulmonary Edema; Pulmonary Embolism; Respiratory Insufficiency; Skin Diseases

Topics: Acute Kidney Injury; Adult; Heroin; Heroin Dependence; Humans; Male; Myoglobinuria; Paralysis

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Gastrointestinal Hemorrhage; Hemiplegia; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Pulmonary Embolism; Respiratory Insufficiency; Splenomegaly; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Coma; Contracture; Female; Heroin; Humans; Ischemia; Male; Muscles; Muscular Diseases; Pressure; Pressure Ulcer; Secobarbital; Skin Diseases; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Biopsy, Needle; Heroin; Heroin Dependence; Humans; Male; Muscles; Muscular Diseases; Myoglobinuria; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Biopsy; Electromyography; Heroin; Humans; Leg; Male; Morphine Dependence; Muscles; Muscular Diseases; Myoglobinuria; Pulmonary Edema

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholic Intoxication; Arm Injuries; Brachial Plexus; Coma; Hemoglobins; Heroin; Humans; Leg Injuries; Male; Myoglobin; Paralysis; Peripheral Nerve Injuries; Pressure; Secobarbital; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Aspartate Aminotransferases; Barbiturates; Chlorpromazine; Coma; Drug-Related Side Effects and Adverse Reactions; Female; Glutethimide; Heroin; Humans; Kidney Function Tests; L-Lactate Dehydrogenase; Male; Methadone; Methamphetamine; Muscular Diseases; Myoglobinuria; Phosphocreatine; Pyruvate Kinase; Quinine; Substance-Related Disorders

Topics: Acute Disease; Acute Kidney Injury; Adult; Autopsy; Cell Membrane Permeability; Drug Contamination; Electromyography; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Muscle Contraction; Muscular Diseases; Myoglobin; Myoglobinuria; Rest; Substance-Related Disorders; Time Factors

Topics: Acute Kidney Injury; Administration, Oral; Adolescent; Alkaline Phosphatase; Amenorrhea; Amphetamine; Barbiturates; Cannabis; Child; Cocaine; Eosinophilia; False Positive Reactions; Female; Hepatic Encephalopathy; Hepatitis B; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Juvenile Delinquency; Lysergic Acid Diethylamide; Peptic Ulcer; Pneumonia; Pseudotumor Cerebri; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Ammonia; Antitussive Agents; Chloroform; Chromatography, Thin Layer; Cocaine; Cyclizine; Heroin; Humans; Hypotension; Ketones; Male; Methods; Morphine; Pharmaceutical Preparations; Substance-Related Disorders