When Coke Is Not Hydrating: Cocaine-Induced Acute Interstitial Nephritis.

Area of Science:

• Nephrology
• Toxicology
• Internal Medicine

Background:

• Acute kidney injury (AKI) is a common clinical problem with various etiologies.
• Cocaine is an infrequent cause of AKI, typically associated with acute tubular necrosis (ATN) or pigment nephropathy.
• Acute interstitial nephritis (AIN) due to cocaine is exceptionally rare, with limited case reports.

Purpose of the Study:

• To report a case of acute interstitial nephritis (AIN) in a patient with a history of cocaine abuse.
• To highlight the importance of considering cocaine as a potential cause of AIN in patients presenting with AKI.
• To emphasize the favorable response to steroid therapy in cocaine-induced AIN.

Main Methods:

• Case presentation of a 47-year-old male with severe AKI, hypertension, and admitted cocaine use.
• Diagnostic workup included comprehensive laboratory tests, imaging studies, and renal biopsy.
• Treatment involved hemodialysis followed by corticosteroid therapy.

Main Results:

• Renal biopsy confirmed acute interstitial nephritis (AIN).
• The patient required hemodialysis but showed significant improvement in renal function after initiating steroid treatment.
• Creatinine levels returned to near baseline within 8 weeks.

Conclusions:

• Cocaine abuse should be considered in the differential diagnosis of acute interstitial nephritis (AIN), especially in middle-aged African American males presenting with AKI.
• Prompt diagnosis and treatment with steroids can lead to favorable renal outcomes in cocaine-induced AIN.
• This case underscores the need for clinicians to inquire about substance abuse in patients with unexplained AKI.