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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.


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Ultrastructural detail of the crystals demonstrates radiating spicules (×5800).
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SFV018F6: Ultrastructural detail of the crystals demonstrates radiating spicules (×5800).

Mentions: Despite the initial fluid resuscitation with 4 L of intravenous normal saline, the patient remained oliguric with 350 mL urine output in the first 24 h of admission. Because of the lack of improvement in his serum creatinine and urine output in the first 72 h, a kidney biopsy was performed. Light microscopy revealed diffuse acute tubular injury with numerous intratubular crystals demonstrating an unusual, finely granular to ‘fluffy,’ deeply basophilic appearance (Figures 3 and 4). Focally, the crystals were associated with tubular rupture and interstitial inflammation. The glomeruli were unremarkable, and there was no significant interstitial fibrosis or tubular atrophy. Direct immunofluorescence microscopy was negative for immune complex deposition. Electron microscopy demonstrated occasional intratubular crystals with peripheral radiating spicules, located within tubular epithelial cells and in the tubular lumens (Figures 5 and 6).Fig. 3.


Heroin crystal nephropathy.

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

Ultrastructural detail of the crystals demonstrates radiating spicules (×5800).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

SFV018F6: Ultrastructural detail of the crystals demonstrates radiating spicules (×5800).
Mentions: Despite the initial fluid resuscitation with 4 L of intravenous normal saline, the patient remained oliguric with 350 mL urine output in the first 24 h of admission. Because of the lack of improvement in his serum creatinine and urine output in the first 72 h, a kidney biopsy was performed. Light microscopy revealed diffuse acute tubular injury with numerous intratubular crystals demonstrating an unusual, finely granular to ‘fluffy,’ deeply basophilic appearance (Figures 3 and 4). Focally, the crystals were associated with tubular rupture and interstitial inflammation. The glomeruli were unremarkable, and there was no significant interstitial fibrosis or tubular atrophy. Direct immunofluorescence microscopy was negative for immune complex deposition. Electron microscopy demonstrated occasional intratubular crystals with peripheral radiating spicules, located within tubular epithelial cells and in the tubular lumens (Figures 5 and 6).Fig. 3.

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