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[Acute renal failure and hypertension crisis after a technoparty]
History:
A 22 year old patient had noted progressive flank pain without recognizable urinary abnormalities for five days.
Investigations:
A urologist had noted increased serum creatine (2.1 mg/dl), hypertension (180/100 mmHg) and microhematuria. A post-renal cause was excluded by excretory urography. An interview revealed that the patient had consumed cocaine on weekends since age 19; the acute episode was preceded by a rave party with consumption of a total of 3 g of street quality cocaine.
Diagnosis And Treatment:
Because of microhematuria with a suggestive nephritic urinary sediment, the patient underwent renal biopsy. It showed acute tubular necrosis and interstitial edema, but no signs of glomerulonephritis and negative immunohistology. The patient received antihypertensive treatment. This led to rapid reversal of elevated serum creatinine and microhematuria was noted, but hypertension persisted. Currently the patient receives ACE inhibitors.
Conclusion:
Similar to what is seen in the US, cocaine use has to be considered in the differential diagnosis of acute renal failure with hypertension.