Cocaine-associated rhabdomyolysis causing renal failure in pregnancy

Cocaine use is known to have multisystemic effects. Recently, acute renal failure as a result of rhabdomyolysis has been described as a complication of cocaine use. During pregnancy, cocaine is associated with abruptio placentae. A patient presenting with both complications is described.

A 25-year-old multiparous woman at 34 weeks' gestation developed abruptio placentae approximately 18 hours after using cocaine alkaloid. Six hours later, a cesarean delivery was performed after she presented with vaginal bleeding and fetal bradycardia. Oliguria was present from admission and persisted despite aggressive fluid hydration, dopamine infusion, and intravenous administration of furosemide. Serum creatinine phosphokinase and urine myoglobin were both elevated at 558 IU/L and 432 ng/mL. Hemodialysis was required for presumed cortical necrosis.

Rhabdomyolysis, as indicated by elevated creatinine phosphokinase and the presence of myoglobin in the urine, suggests that nephrotoxicity from myoglobinuria may contribute to acute renal failure in cases of cocaine mediated abruptio placentae.