Cocaine can result in acute kidney injury and renal failure. One mechanism is an interstitial nephritis.
Clinical features may include:
(1) a history of recent and heavy cocaine abuse
(2) new onset of or worsening of hypertension
(3) nausea
(4) abdominal pain
(5) decreased urine output
(6) hematuria
Laboratory findings:
(1) increase in serum creatinine concentration
(2) negative tests for autoantibodies, c-ANCA, and p-ANCA
(3) positive blood or urine test for cocaine or its metabolites.
(4) hair testing may be considered if urine and blood tests are negative but history suspicious
The diagnosis rests on a renal biopsy showing interstitial nephritis.
Differential diagnosis:
(1) other mechanisms of cocaine-associated renal injury
(2) interstitial nephritis due to drugs or chemicals used to "cut" the cocaine
(3) other conditions associated with interstitial nephritis
Therapy with corticosteroids may reduce the inflammation and improve renal function but no prospective randomized trials have been performed.
