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Heroin crystal nephropathy.

Bautista JE, Merhi B, Gregory O, Hu S, Henriksen K, Gohh R - Clin Kidney J (2015)

Bottom Line: These crystals are also identified in light and electron microscopy.We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury.Management is mainly supportive as there is no known specific therapy for this condition.

View Article: PubMed Central - PubMed

Affiliation: Division of Kidney Disease and Hypertension, Department of Medicine , Rhode Island Hospital, Brown University School of Medicine , Providence, RI , USA.

ABSTRACT
In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy.

No MeSH data available.


Related in: MedlinePlus

Urine microscopy showing numerous crystals with broomstick-like configuration (×100).
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SFV018F1: Urine microscopy showing numerous crystals with broomstick-like configuration (×100).

Mentions: A 42-year-old male with history of untreated hepatitis C and polysubstance abuse was admitted for AKI and severe metabolic alkalosis. One day prior to admission, he admitted to having injected a massive amount of heroin and subsequently presented with nausea, vomiting and altered mental status. On presentation, his vital signs revealed a blood pressure of 120/80, heart rate of 98, respiratory rate of 10 and a temperature of 98°F. The rest of his physical exam was normal. His blood chemistry showed Na 138 meq/L, Cl 63 meq/L, HC03 more than 56 meq/L, BUN 67 mg/dL, creatinine 4 mg/dL, and normal creatinine kinase. Arterial blood gas showed pH 7.55, pCO2 82, and tC02 73 consistent with severe metabolic alkalosis and concomitant respiratory acidosis. His urine electrolytes revealed Na 40 meq/L, Cl 28 meq/L, creatinine 43 mg/dL, and osmolality 261 mOsm/kg, with a fractional excretion of sodium (FENa) of 2.72%. Urinalysis was negative for glucose, blood, protein, white blood cells or eosinophils, while the urine pH was >8. Urine microscopy showed packed crystals that resembled broomsticks without renal tubular epithelial cells or casts (Figure 1 low power and Figure 2 high power). Renal ultrasound showed two normal size echogenic kidneys without hydronephrosis or calculi.Fig. 1.


Heroin crystal nephropathy.

Bautista JE, Merhi B, Gregory O, Hu S, Henriksen K, Gohh R - Clin Kidney J (2015)

Urine microscopy showing numerous crystals with broomstick-like configuration (×100).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440465&req=5

SFV018F1: Urine microscopy showing numerous crystals with broomstick-like configuration (×100).
Mentions: A 42-year-old male with history of untreated hepatitis C and polysubstance abuse was admitted for AKI and severe metabolic alkalosis. One day prior to admission, he admitted to having injected a massive amount of heroin and subsequently presented with nausea, vomiting and altered mental status. On presentation, his vital signs revealed a blood pressure of 120/80, heart rate of 98, respiratory rate of 10 and a temperature of 98°F. The rest of his physical exam was normal. His blood chemistry showed Na 138 meq/L, Cl 63 meq/L, HC03 more than 56 meq/L, BUN 67 mg/dL, creatinine 4 mg/dL, and normal creatinine kinase. Arterial blood gas showed pH 7.55, pCO2 82, and tC02 73 consistent with severe metabolic alkalosis and concomitant respiratory acidosis. His urine electrolytes revealed Na 40 meq/L, Cl 28 meq/L, creatinine 43 mg/dL, and osmolality 261 mOsm/kg, with a fractional excretion of sodium (FENa) of 2.72%. Urinalysis was negative for glucose, blood, protein, white blood cells or eosinophils, while the urine pH was >8. Urine microscopy showed packed crystals that resembled broomsticks without renal tubular epithelial cells or casts (Figure 1 low power and Figure 2 high power). Renal ultrasound showed two normal size echogenic kidneys without hydronephrosis or calculi.Fig. 1.

Bottom Line: These crystals are also identified in light and electron microscopy.We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury.Management is mainly supportive as there is no known specific therapy for this condition.

View Article: PubMed Central - PubMed

Affiliation: Division of Kidney Disease and Hypertension, Department of Medicine , Rhode Island Hospital, Brown University School of Medicine , Providence, RI , USA.

ABSTRACT
In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy.

No MeSH data available.


Related in: MedlinePlus