Acute Renal Failure in Cocaine Users: Pathology Correlates.
Guillermo A Herrera, Elba A Turbat-Herrera. Nephrocor, Tempe, AZ
Background: A subset of patients using cocaine develop acute renal failure. Most of these patients do not volunteer the information that they have used cocaine in the immediate period prior to the development of renal failure. The mechanisms involved appear to be multifactorial and involve vasoconstriction with tubular injury and direct effect of the cocaine on proximal tubules where it is normally metabolized, as well as a possible hypersensitivy reaction to either cocaine itself or to other products admixed with it.
Design: A review of 2376 renal biopsies over a 4 year period revealed 12 cases with cocaine-related acute renal failure. The study is carried out to identify the histopathological, ultrastructural, and immunohistochemical findings associated with this entity.
Results: An antibody to cocaine metabolites identified the presence of these in proximal tubular cells in all cases. The pathology identified included acute tubular injury and a generally subdued interstitial inflammatory process associated with tubulitis and tubular damage. The inflammatory cells were predominantly lymphocytes and plasma cells, but eosinophils were present in most cases, albeit in variable numbers. By immunohistochemistry cocaine metabolites are identified in the cytoplasm of proximal tubular cells. Ultrastructurally, the damaged proximal tubules reveal large secondary lysosomes with particulate matter inside, a rather typical marker.
Conclusions: Identifying cases of cocaine-related acute renal failure requires a high index of suspicion as the pathologic findings are rather non-specific and often, quite focal and unimpressive. Ultrastructural evaluation is helpful to detect specific changes in damaged proximal tubular cells suggestive of recent cocaine use. This is very helpful to suggest a possible cocaine etiology for the tubular damage and may lead to the request for immunohistochemistry for cocaine metabolites. Immunohistochemistry stain for cocaine metabolites may provide a reliable marker to identify these cases.
Category: Kidney (does not include tumors)
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 253, Wednesday Afternoon