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Cocaine-induced renal artery dissection and thrombosis leading to renal infarction

David A Edmondson1, Jonathan B Towne, Dennis W Foley

  • 1Medical College of Wisconsin, Milwaukee 53226, USA.

WMJ : Official Publication of the State Medical Society of Wisconsin
|February 9, 2005
PubMed

Insights

Cocaine use can cause renal artery dissection and thrombosis. A genetic predisposition, methyltetrahydrofolate reductase polymorphism, may contribute to recurrent clot formation and elevated homocysteine levels.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Genetics

Background:

  • Renal artery dissection and thrombosis are rare but serious conditions.
  • Cocaine abuse is an identified risk factor for vascular events.

Observation:

  • A 40-year-old man presented with symptoms suggestive of recurrent renal artery thrombosis.
  • Initial presentation was linked to cocaine use, treated with surgery and anticoagulation.

Findings:

  • Recurrent clot formation in the renal artery was observed despite cessation of cocaine use.
  • Genetic analysis revealed a methyltetrahydrofolate reductase (MTHFR) A1298C/C677T double heterozygous thermolabile polymorphism.
  • Elevated serum homocysteine levels were detected, suggesting a potential genetic contribution to hypercoagulability.

Implications:

  • This case highlights the potential for MTHFR polymorphism to predispose individuals to recurrent vascular events, even after removal of an inciting factor like cocaine.
  • Understanding genetic factors like MTHFR mutations is crucial for managing patients with recurrent thrombosis.
  • Further research is warranted to explore the link between MTHFR polymorphisms, hyperhomocysteinemia, and drug-induced vascular complications.

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