Abstract: SA-PO264
A Rare Case of Methamphetamine Induced Thrombotic Microangiopathy and End Stage Renal Failure
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Guruswamy sangameswaran, Kothai divya, OU -Tulsa School of Community Medicine, Tulsa, Oklahoma, United States
- Baradhi, Krishna M., OU -Tulsa School of Community Medicine, Tulsa, Oklahoma, United States
Group or Team Name
- OU Tulsa
Introduction
Recreational drug abuse is not only a major public health problem with significant morbidity and mortality, but also one of the frequently neglected risk factors for End Stage Renal Disease (ESRD). Amongst these inconsiderate risk factors, methamphetamine induced Thrombotic Microangiopathy (TMA) and ESRD is indeed a rare entity. We report a rare case of ESRD from methamphetamine induced TMA and stress the importance of recognizing methamphetamine as a cause of ESRD.
Case Description
A 26 year-old-man with history of drug abuse presented with fatigue, dyspnea and epistaxis for two weeks. Exam revealed a pale young man with tachycardia, pedal edema and a BP of 210/124 mm of Hg. Labs showed hemoglobin of 5gm/dl with mild thrombocytopenia and renal failure with BUN of 171mg/dl and creatinine of 20mg/dl. Peripheral smear revealed schistocytes, consistent with microangiopathic hemolysis, yet did not favor hemolytic uremic syndrome-thrombotic thrombocytopenic purpura due to minimally elevated LDH, normal haptoglobin, bilirubin and ADAMTS13 activity.
Serological work up for vasculitis was unrevealing and a renal biopsy was done which showed thrombotic microangiopathic injury and advanced glomerulosclerosis. He was declared ESRD based on biopsy and remained dialysis-dependent. TMA induced ESRD is doubtlessly from methamphetamine abuse, as the patient admitted to using crystal methamphetamine on a weekly basis for many years with several episodes of hypertensive surges as evident by severe left ventricular hypertrophy on echocardiogram.
Discussion
Methamphetamine is a psycho-stimulant, sympathomimetic drug, well known to cause systemic hypertension and cardiomyopathy. A recent study from South Africa showed malignant hypertension in 44.7% and chronic kidney disease in 95.7% of methamphetamine users. Our case report illustrates the need for detailed drug history and considering methamphetamine as a potential cause of TMA and ESRD, as early identification and cessation of drug abuse could prevent irreversible renal damage.