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CURRENT ISSUEGAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

A Journal on Internal Medicine and Pharmacology

Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index

Frequency: Monthly

ISSN 0393-3660

Online ISSN 1827-1812

 

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 August;163(4):127-9

    CLINICAL CASES

Acute re­nal fail­ure as­so­ciat­ed with co­caine and al­co­hol ­abuse

Del Ben M., Angelico F., Alessandri F., Alessandri C.

Department of Experimental Medicine and Pathology, “La Sapienza” University of Rome, Rome, Italy

A ­broad spec­trum of re­nal dis­eas­es is re­port­ed in co­caine ­abuse sub­jects, nev­er­the­less the path­o­gen­e­sis of the ­acute tem­po­rary re­nal fail­ure is un­clear. Cocaine may in­duce rhab­dom­yo­ly­sis and/or re­nal vaso­con­stric­tion be­ing a pow­er­ful sym­pa­thom­i­meth­ic ­drug and in ­turn re­nal fail­ure. A 20-­year-old man de­vel­oped a re­ver­sible ­acute re­nal fail­ure fol­low­ing an epi­sode of co­caine and al­co­hol ­abuse. He was ad­mit­ted for ol­i­gu­ria, swell­ing, ­pain and re­duced ­strength in the ­left low­er ­limb. The in­crease of ser­um crea­ti­nine and mus­cu­lar en­zymes and the pres­ence of uri­nary gran­u­lar and ja­line ­casts ­were sug­ges­tive of rhab­dom­yo­ly­sis and re­nal dam­age. The clin­i­cal pic­ture com­plete­ly re­cov­ered af­ter 15 ­days ­from the on­set. We be­lieve ­that an in­tense ar­te­ri­al vaso­con­stric­tion was the ­more prob­able mech­a­nism of rhab­dom­yo­ly­sis and ­acute re­nal fail­ure in ­this pa­tient ­both be­cause re­nal func­tion re­cov­ered 5 ­days af­ter ­forced diu­re­sis and be­cause bi­o­chem­i­cal in­di­ces of re­nal ac­tiv­ity ­were al­ways nor­mal dur­ing 4 ­months af­ter hos­pi­tal dis­charge. Moreover, the re­port ­that the con­tem­po­rary in­ges­tion of al­co­hol and co­caine has an ad­di­tive and syn­er­gis­tic ef­fect caus­ing the he­pat­ic pro­duc­tion of co­cae­thy­lene, a me­tab­olite ­able to in­crease the system­ic tox­ic ef­fects of co­caine, may sup­port our hy­poth­e­sis.

language: English


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