Spectrum of acute kidney injury associated with cocaine use: report of three cases.

BACKGROUND: The consequences of cocaine use are multisystemic, such as, for instance, renal failure, hepatotoxicity and pulmonary toxicity, with renal alterations being the focus of the present study. The use of substances that modify the base composition of cocaine (or adulterants) aiming to potentiate its effects also has an impact on these manifestations. The present study aims to report three cases with different diagnosis of acute kidney injury related to cocaine use. CASE PRESENTATION: Case 01 - A 30-year-old female patient, who regularly used cocaine, started to have lower-limb edema, which showed a progressive and ascending evolution, affecting the face a few days later, associated with an isolated febrile episode and oligoanuria. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) was verified: reactive 1:80, with renal biopsy compatible with rapidly progressive glomerulonephritis (RPGN). Case 02 - A 34-year-old female patient, with difficult-to-control hypertension and a frequent user of cocaine, showed generalized sudden edema together with diffuse and progressive pruritus associated with oliguria, fever, nausea, and vomiting. Schistocyte screening was positive, with negative direct Coombs test, and negative serologies for hepatitis B, C and HIV, as well as negative anti-double-stranded DNA, Anti-SSA and Anti-SSB. The renal biopsy was compatible with thrombotic microangiopathy, associated with moderate interstitial fibrosis and acute tubular necrosis Case 03 - A 25-year-old male patient who had been a cocaine user for 5 years had a sudden onset of generalized disabling myalgia (especially in the lower limbs) associated with recent frontotemporal headache, palpitation, dizziness, and a non-measured febrile episode; the patient had used cocaine at the night before symptom onset. CPK was 1731 U/L.The final probable diagnosis was AKI secondary to cocaine-induced rhabdomyolysis. CONCLUSIONS: In conclusion basically, 05 etiologies of acute kidney injury should always be remembered: rhabdomyolysis, thrombotic microangiopathy, vasculitis, acute interstitial nephritis and renal infarction. Emphasis should be given to rhabdomyolysis due to its higher prevalence. Considering the increasing rates of cocaine use, especially with the use of adulterating substances, these pathologies will likely be increasingly prevalent.

Visceral Leishmaniasis hospitalizations and seasonality in Fortaleza, Ceará, Northeast Brazil between 2003 ­ 2012 / Hospitalização por leishmaniose visceral e sazonalidade em Fortaleza, Ceará, Nordeste do Brasil entre 2003 e 2012

Introduction: The knowledge of the relationship between Visceral Leishmaniosis and climatic aspects is already well established in the literature of other countries, but lack data of this relationship in Brazil. Objective: This study aimed to describe the seasonal distribution of hospitalizations for Visceral Leishmaniosis (VL) in a referral hospital for infectious diseases located in an endemic area of the semiarid in the Northeast of Brazil. Methods: The number of monthly hospitalizations between 2003 and 2012 was recorded retrospectively and was correlated with climate variables. Results: During this period 1,302 patients were hospitalized. We observed an inverse relationship with the monthly amount of precipitation (r = - 0.725; p = 0.008), the number of days per month with precipitation (r = - 0.683; p = 0.0144) and relative humidity (r = - 0.746; p = 0.005) when compared with the monthly number of hospitalizations due to VL. Inversely, there was a direct relationship with the maximum monthly mean temperature and the number of hospitalizations due to VL (r = 0.643; p = 0.024). Conclusions: The rainy season, characterized by more rainfall and higher humidity, was correlated with fewer hospitalizations for VL. Conversely, in months with higher temperatures the number of hospitalizations for VL was higher.