娱乐性药物使用导致的肾梗塞很少见,通常与可卡因使用有关。虽然安非他明和可卡因有相似的作用机制,很少有报道将它们与缺血事件联系起来,只有一个肾梗塞。同样,很少有报告将海洛因的使用与梗塞联系起来,但从来没有在肾脏。虽然不常见,海洛因和苯丙胺引起的梗塞涉及几种机制,包括血管病变,血管炎和凝血级联的激活。
47岁女性,有非静脉注射海洛因和苯丙胺滥用的既往病史,慢性阻塞性肺疾病,高血压,高脂血症表现为右下肢肿胀和皮疹,被诊断为蜂窝织炎并得到适当治疗。顺便说一句,该患者被发现有急性肾损伤,进一步检查发现右肾有多个肾梗死。患者没有凝血障碍的既往病史。血培养和尿培养均无菌;自身免疫和高凝检查均为阴性。尿液分析并不明显。尿液毒理学仅对阿片类药物和苯丙胺呈阳性,这被认为是最可能导致肾梗塞的原因。患者因不合规而无法接受门诊随访,但由于她的蜂窝织炎再次出现而返回医院,在此期间没有发现新的梗塞,之前的肾梗塞已经伤痕累累。
关于海洛因和苯丙胺引起的梗塞的报道很少。此病例报告描述了海洛因/苯丙胺滥用的一种罕见但重要的并发症,很容易被忽视。
Renal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few
reports linking them to ischemic events, and only one to renal infarction. Similarly, few
reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade.
47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over.
There are very few
reports of heroin and amphetamine-induced infarctions. This
case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.