A patient who abuses cocaine may develop renal failure by a number of different mechanisms.


Possible causes of renal failure in a person who abuses cocaine:

(1) rhabdomyolysis

(2) vasoconstriction of the renal artery with ischemia

(3) thromboembolic disease

(4) arterial thrombotic microangiopathy

(5) direct toxic effect on the proximal tubular cells


Cocaine abuse may be denied by the patient initially. The diagnosis should be suspected if the patient has:

(1) unexplained rhabdomyolysis

(2) a positive urine drug screen for cocaine

(3) clinical history of drug abuse

(4) clinical findings associated with drug abuse (injection sites, defect in the nasal septum, etc)


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