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Published on: July 17, 2016
Methamphetamine intoxication and acute kidney injury: A prospective observational case series
Katherine Z Isoardi1,2, David W Mudge2,3, Keith Harris1,2
1Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.
Aim:
The effects of methamphetamine intoxication on the kidney are not well reported. We aimed to investigate acute kidney injury (AKI) associated with methamphetamine intoxication, in particular its severity, duration and association with rhabdomyolysis.
Methods:
This is a prospective observational series of methamphetamine-intoxicated patients presenting to an Emergency Department. Patients self-reporting recent methamphetamine use, with a positive urine drug screen and an elevated creatinine, were eligible for the study. Urinary neutrophil gelatinase-associated lipocalin (NGAL) was measured, and serum creatinine, creatine kinase and cystatin C concentrations were performed on arrival and at several time points until discharge from hospital. Demographic and clinical data were obtained from the medical records.
Results:
There were 634 presentations with methamphetamine intoxication over a 10-month period, with 73/595(12%) cases having an elevated serum creatinine concentration on arrival. Fifty presentations in 48 patients were included in the study. Most patients (85%) were male with a median age of 32 years. The median serum creatinine concentration on presentation was 125 μmol/L (IQR:113-135 μmol/L) with 45 (90%) presentations meeting diagnostic criteria for AKI. Concurrent rhabdomyolysis occurred in 22 (44%) presentations with a median CK of 2695 U/L (IQR:1598-5060 U/L). Cystatin C was elevated (> 0.98 mg/L) in 18 cases. An elevated NGAL concentration (>150 μg/L) was present in five (10%) cases. No patients required dialysis. The median length of stay was 19 hours (IQR 14-24 hours).
Conclusion:
AKI is common in methamphetamine intoxication. The kidney injury is relatively mild and short-lived, resolving with crystalloid therapy.
Insights
Acute kidney injury (AKI) is common in methamphetamine intoxication, often occurring with rhabdomyolysis. This kidney damage is typically mild and resolves quickly with standard fluid treatment.
Area of Science:
- Nephrology
- Toxicology
- Emergency Medicine
Background:
- Methamphetamine intoxication's impact on kidney function is not well-documented.
- Acute kidney injury (AKI) is a potential complication requiring further investigation.
Purpose of the Study:
- To investigate the incidence, severity, and duration of AKI in methamphetamine-intoxicated patients.
- To explore the association between AKI and rhabdomyolysis in this population.
Main Methods:
- Prospective observational study of methamphetamine-intoxicated patients in an Emergency Department.
- Inclusion criteria: self-reported methamphetamine use, positive urine drug screen, elevated creatinine.
- Measurements included serum creatinine, creatine kinase, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL).
Main Results:
- 12% of methamphetamine intoxication presentations had elevated creatinine; 90% of included patients met AKI criteria.
- Rhabdomyolysis occurred in 44% of cases, with elevated creatine kinase (CK).
- AKI was generally mild and short-lived; no patients required dialysis.
Conclusions:
- Acute kidney injury is a frequent complication of methamphetamine intoxication.
- The kidney injury is typically mild and resolves with crystalloid therapy.
- Rhabdomyolysis is a common co-occurring condition.
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