Kidney Disease and Electrolyte Disorders in the Context of Drug Use

Abstract

The kidneys receive approximately 25% of cardiac output and are highly exposed to the influence of drugs of addiction. While many drugs have long been known to cause kidney injury or other metabolic derangements, such as electrolyte and acid-base disorders, the mechanism and the longer-term implications of many drug-induced kidney diseases often remain poorly understood. However, both drug-induced kidney injury and pre-existing kidney disease are frequently encountered in primary care, acute medicine and critical care and when treating people with a history of drug use or addiction. Here, we define the classification and presentation of renal disease before describing the wide spectrum of renal disease associated with drugs of addiction. Both direct nephrotoxicity and indirect injury stemming from injecting drug use, such as the renal complications of blood-borne viruses, are reviewed. In addition, the interaction between drug use and chronic kidney disease and renal replacement therapy is briefly considered. Finally, we describe the spectrum of electrolyte and acid-base derangements associated with drug use.