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

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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