Abstract
BackgroundCocaine abuse has been known to have detrimental effects on the cardiovascular system. Its toxicity has been associated with myocardial ischemia, cerebrovascular accidents and mesenteric ischemia. The pathophysiology of cocaine-related renal injury is multifactorial and involves renal hemodynamic changes, alterations in glomerular matrix synthesis, degradation and oxidative stress, and possibly induction of renal atherogenesis. Renal infarction as a result of cocaine exposure, however, is rarely reported in the literature.Case presentationA 48 year-old male presented with a four-day history of severe right flank pain following cocaine use. On presentation, he was tachycardic, febrile and had severe right costovertebral angle tenderness. He had significant proteinuria, leukocytosis and elevated serum creatinine and lactate dehydrogenase. Radiographic imaging studies as well as other screening tests for thromboembolic events, hypercoagulability states, collagen vascular diseases and lipid disorders were suggestive of Cocaine-Induced Renal Infarction (CIRI) by exclusion.ConclusionIn a patient with a history of cocaine abuse presenting with fevers and flank pain suggestive of urinary tract infection or nephrolithiasis, cocaine-induced renal infarction must be considered in the differential diagnosis. In this article, we discuss the prior reported cases of CIRI and thoroughly review the literature available on this disorder. This is important for several reasons. First, it will allow us to discuss and elaborate on the mechanism of renal injury caused by cocaine. In addition, this review will demonstrate the importance of considering the diagnosis of CIRI in a patient with documented cocaine use and an atypical presentation of acute renal injury. Finally, we will emphasize the need for a consensus on optimal treatment of this disease, for which therapy is not yet standardized.
Highlights
Cocaine abuse has been known to have detrimental effects on the cardiovascular system
In a patient with a history of cocaine abuse presenting with fevers and flank pain suggestive of urinary tract infection or nephrolithiasis, cocaine-induced renal infarction must be considered in the differential diagnosis
This review will demonstrate the importance of considering the diagnosis of Cocaine-Induced Renal Infarction (CIRI) in a patient with documented cocaine use and an atypical presentation of acute renal injury
Summary
Renal infarction as a result of cocaine use, is uncommon. In a patient with a history of cocaine abuse presenting with fevers and flank pain suggestive of urinary tract infection or nephrolithiasis, cocaine-induced renal infarction must be considered in the differential diagnosis. The vasoconstrictive and thrombotic effects of cocaine are most likely the dominant factors in cocaine-induced renal infarction. The possible atherogenic effect of cocaine and the relationship of this effect to renal infarct is likely to be a long term, rather than an acute factor. The diagnosis of CIRI is based on exclusion of other entities that cause renal infarct (e.g. hypercoagulable states due to factor deficiency, autoimmune diseases and thromboembolic events), in conjunction with documented cocaine use and appropriate radiographic studies. The extent of the renal infarct will likely influence clinical management and outcome. Antithrombotic, conservative managements as well as surgical approaches have been attempted with variable success, perhaps the most plausible treatment would be to prevent this misfortune by patient education
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
