Acute Renal Failure in a Young Healthy Male

1Mount Sinai Englewood Hospital and Medical Center, Englewood, NJ
2Mount Sinai Englewood Hospital and Medical Center, Englewood, NJ
3Mount Sinai Englewood Hospital and Medical Center, Englewood, NJ
4Mount Sinai Englewood Hospital and Medical Center, Englewood, NJ

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 482

Case Presentation:

A 20‐year‐old healthy man with no significant medical history presented to the emergency department with multiple episodes of watery, bilious, nonbloody vomiting associated with nausea and poor oral intake for 3 days. He also had an episode of watery diarrhea. The patient denied any fever, chills, abdominal pain, recent respiratory tract infections, ill contacts, new medications, eating outside or loss of weight. Physical examination including abdomen was normal and no tenderness was elicited. His initial labs were significant for white blood cell count of 20,700/μL, chloride of 88 mg/dL, blood urea nitrogen of 39 mg/dL and creatinine of 4.3 mg/dL. Urine sodium was 83 mg/dL and fractional excretion of sodium was calculated to be 3.4%. Urine analysis was negative for cast, sediments, eosinophils, glucose or protein. The patient was treated with IV fluid hydration and antiemetics. Ultrasonogram demonstrated bilateral echogenic kidneys with no atrophy or hydronephrosis. There was no prior documented imaging for comparison. Nephritic workup including hepatitis B and C, HIV, C3C4, ASO, anti‐GBM, ANA, and anti‐DNA were negative. After extensive further questioning, patient admitted to smoking “K2,” which is a synthetic cannabinoid for 3 days during the week before he presented. Urine drug toxicity panel was pan negative including for cannabinoids. Other causes for acute gastroenteritis including Giardia, Salmonella, Shigella, and Campylobacter were ruled out. He improved symptomatically and started tolerating oral feeds, hence renal biopsy was withheld. The patient was discharged after 4 days in the hospital with serum creatinine of 2 mg/dL and blood urea nitrogen of 21 mg/dL. He was advised strictly not to use those drugs anymore. The patient was followed up after 6 weeks, and repeat labs showed normal renal function.

Discussion:

This case report describes acute renal failure in a young healthy ma possibly due to “K2” abuse, which is uncommonly reported. The cause of acute renal failure is explained by intrinsic renal injury with high fractional excretion of sodium despite multiple episodes of vomiting and poor oral intake. Other causes of acute kidney injury and bilateral echogenic kidneys were excluded by exhaustive workup.

Conclusions:

Use of synthetic cannabinoids, marketed as “K2” or “spice,” has been on the rise as a legal alternative to marijuana due to its easy availability as herbal incense. According to data from the 2011 Monitoring the Future survey of youth drug‐use trends, it is the second most commonly used illicit drug among 12th‐graders. Despite their alarmingly increased prevalence, very little is known about their clinical effects, metabolism and toxicology. The fact that these drugs are not easily detected by standard toxicology tests presents “K2” abuse a challenge to practicing physician. It should be of high suspicion especially in the young adult population when being evaluated for possible substance abuse even with negative toxicology screening.

To cite this abstract:

Krishnamoorthy P, Kishore S, Adams D, Coleman C. Acute Renal Failure in a Young Healthy Male. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 482. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/acute-renal-failure-in-a-young-healthy-male/. Accessed May 20, 2019.

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