Heroin Epidemic and Acute Kidney Injury: An Under-Recognized but Important Consequence of Opioid Overdose

Abstract

Heroin abuse and overdose are increasing at an alarming rate in the United States. Due to its relatively low cost and ease of availability, over a million people are abusing this agent. What is most disturbing is the fact that heroin-associated deaths have tripled over the past 5 years. While heroin has a major negative impact on the cardiopulmonary system, acute kidney injury (AKI) following heroin overdose is emerging as a major problem. AKI increases mortality and is a major cause of the development of chronic kidney disease and its antecedent long-term mortality. Timely diagnosis of AKI and its treatment reduces mortality. In this article, we present two cases (a 25-year-old man and a 22-year-old woman) of heroin-induced AKI. Both presented with altered mental status, respiratory depression and low blood pressure. AKI was diagnosed by the treating internist in a timely fashion and optimally treated in the 25-year-old man. In the 22-year-old woman who presented to the emergency department, AKI could not be recognized. She was discharged home after the management of overdose with resolution of pulmonary and neurological issues. Six days later, she returned to the emergency department with shortness of breath, volume overload, and severe acute tubular necrosis, required hemodialysis and left the hospital with serum creatinine of 2.5 mg/dL (estimated glomerular filtration rate (eGFR) = 46 mL/min). At a 7-month follow-up, this patient continues to have eGFR of 45 mL/min (stage III chronic kidney disease). This article presents the mechanism of heroin-induced AKI as well as its management strategy and calls for heightened awareness for early diagnosis and prompt treatment.




J Med Cases. 2017;8(10):305-310
doi: https://doi.org/10.14740/jmc2898w