Atypical Presentation of Cocaine-Induced Thrombotic Microangiopathy
American Journal of Kidney Diseases
; 79(4):S37-S38, 2022.
Article
in English
| EMBASE | ID: covidwho-1996885
ABSTRACT
Cocaine is one of the most used illicit drugs. Cocaine induced toxicity can result in hepatotoxicity, pulmonary toxicity, and renal dysfunction. Acute kidney injury (AKI) is an emergent complication in cocaine abusers. Rhabdomyolysis and vasoconstrictions mechanism are well known cause of AKI, cocaine induce thrombotic microangiopathy (TMA) is rarely reported. Cocaine is widely used in the United States, we report a case of Cocaine induced TMA in a cocaine abuser. We chronicle a case of a 42-Year-old male cocaine abuser, who presented to ED with complaints of Dyspnea, cough, anorexia and chest tightness for two days. He attributed to inhaling ammonia from cat urine along with cocaine abuse. No prior history of kidney disease or any other chronic illness. On examination, the patient appeared malnourished and cachectic. He was normotensive, lethargic and oriented. There were crackles at the lung bases. Blood tests revealed serum creatinine 18.0 mg/dL, blood urea nitrogen 150 mg/dL, hemoglobin 8.2 g/dL, platelets 173000/mm3, Retics count 8 %, LDH 1120 (84–246 IU/L) and haptoglobin < 8 (30–200mg/dL). A blood film revealed occasional schistocytes. Urinalysis showed proteinuria and microscopic hematuria. Urine toxicology revealed cocaine. Routine blood and urine cultures showed no growth. Serologic tests showed reduced complement C3 level of 40 (82-185 mg/dL) and normal C4 level of 32 (10–53mg/dL). There were no antibodies against HIV 1/2 and Covid 19. His ADAMTS-13 results showed 0.61 and 0.63 (0.68 to 1.63). Renal Ultrasound was unremarkable. Patient was intubated and ventilated in ICU;he was initiated on hemodialysis. He was provided four sessions of plasma exchanges till his ADAMTS-13 result came back near normal that was indicative of Cocaine induce TMA. Cocaine abuse is a global issue with increasing number of cases in the USA. It can cause AKI due to well-known etiologies like Rhabdomyolysis, Vasculitis, Acute interstitial Nephritis and Renal Infarction. However, Clinicians and nephrologists should also consider rare causes like TMA as a possible differential cause of AKI in the setting of cocaine abuse.
ammonia; cocaine; complement component C3; endogenous compound; haptoglobin; hemoglobin; von Willebrand factor cleaving proteinase; acute kidney failure; adult; animal cell; animal experiment; animal tissue; anorexia; artificial ventilation; cachexia; cat; chest tightness; chronic disease; conference abstract; coronavirus disease 2019; coughing; crackle; creatinine blood level; drug toxicity; dyspnea; gene expression; hematuria; hemodialysis; human; Human immunodeficiency virus 1; interstitial nephritis; kidney disease; kidney infarction; male; nephrologist; nonhuman; plasma exchange; proteinuria; rhabdomyolysis; schistocyte; serology; thrombocyte; thrombotic microangiopathy; toxicology; ultrasound; United States; urea nitrogen blood level; urinalysis; urine culture; vasculitis; vasoconstriction
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Database:
EMBASE
Language:
English
Journal:
American Journal of Kidney Diseases
Year:
2022
Document Type:
Article
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