Abstract: SA-PO075
AKI due to Cocaine-Induced Thrombotic Microangiopathy
Session Information
- AKI: Mechanisms - III
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
Author
- Elsayed, Ingi A S, UHNM, Stoke-on-Trent, United Kingdom
Introduction
Thrombotic microangiopathy (TMA) is a rare potentially life-threatening condition caused by small-vessel platelet microthrombi. TMA Syndromes include thrombotic thrombocytopenia purpura (TTP), Shiga toxin mediated haemolytic uremic syndrome (STEC-HUS), drug induced TMA(DITMA) & complement mediated TMA. Clinical features include microangiopathic haemolytic anaemia & thrombocytopenia, & may have acute kidney injury, neurological abnormalities & cardiac ischemia. Drug induced TMA is either immune mediated or non-immune mediated. cocaine use is associated with non-immune DITMA.
Case Description
A case of 29-year-old male known HTN & T2DM, presented with abdominal pains, found to have microangiopathic haemolytic anaemia, thrombocytopenia & acute kidney injury (Table 1). Initially he denied the use of any recreational drugs. His presentation was suggestive of TTP; he was treated by plasma exchange & acute hemodialysis. Following day; he became comatose with a GCS of 7/15; He was transferred to ICU; where he was supported using, mechanical ventilation, inotropic support & he continued on plasma exchange. An emergency CT head showed multiple infarctions.
National Complement Centre recommended starting IV Eculizumab; pending further results. Toxin mediated HUS (E.coli O157) was excluded. His ADAMTS13; was normal. Complement mediated TMA was investigated for (immunologic & genetic evalauation) & was also negative; by then he had received two doses of Eculizumab. The decision was to halt further Eculizumab & plasma exchange. Further corroboration from patient & his family; revealed he used cocaine recreationally prior to admission. Serum toxicology samples from admission, confirmed cocaine. We believe that this a case of non-immune DITMA. Performing a native renal biopsy , was deemed inappropriate due to high risk involved & minimal benefit. He remained dialysis-dependent throughout & was discharged after a period of neurorehabilitation, where he continues to dialyse thrice weekly.
Discussion
Cocaine use is associated with TMA although rarely reported & admitting physician need to be alert of this possibility.
Table 1
| Serum Creatinine | 1224 micromol/L |
| Hb | 80g/L |
| Blood film | Moderate Schistocytes |
| LDH | 2994 IU/L |
| DCT | Negative |
| Reticulocytes | 170 (raised) |