Acute tubulointerstitial nephritis due to recreational cocaine use

Abstract

Introduction: acute tubulointerstitial nephritis (ATIN) is a type of hypersensitivity kidney injury that mainly affects the interstitium and leads to potentially reversible acute kidney injury (AKI). The most common etiologies are medications, infections, autoimmune diseases, and herbal and toxic products, with cocaine-related ATIN rarely reported (1).

Case presentation: we present the case of a patient with ATIN secondary to cocaine use who debuted with AKI that required renal replacement therapy (RRT). After discontinuing the toxin and treating with high-dose glucocorticoids (GCs), he had a favorable clinical course.

Discussion: cocaine causes AKI through vasoconstriction, oxidative stress, and platelet activation, and may cause rhabdomyolysis, vasculitis, thrombotic microangiopathy, kidney infarction and, rarely, ATIN. Given the nonspecific presentation of the latter, a high index of suspicion and a kidney biopsy are needed to confirm the diagnosis. Treatment consists of suspending the toxin and considering the use of GCs if there is no improvement within 3-7 days. The prognosis depends on prompt identification to prevent permanent kidney damage.

Conclusion: ATIN secondary to cocaine use is a rare condition whose prompt diagnosis and treatment favors complete or partial recovery of kidney function and reduces the need for permanent RRT.