Drug abuse and kidney

Hippokratia 2011; 15 (Suppl 2): 4-8

K. Pantelias, E. Grapsa


Over the past 30 years, the number of drugs’ dependents has increased. Drugs cause psychosomatic changes and ultimately death. The rapid increasing of illicit drug use is an important social health problem. Their use may be therapeutic under medical supervision or illegal by users in dependency. The majority of these substances or their metabolites are excreted through the kidneys and renal complications of drug abuse are frequently encountered. They include a wide range of glomerular, interstitial and vascular diseases. The damage may be acute and reversible or chronic and may lead to end stage renal failure. The involvement of the kidney in drug use is either attributed to their elimination through it, to a direct nephrotoxic effect, or through other mechanisms. Acute renal failure (ARF) can be caused by rhabdomyolysis, hypotension and dehydration or by the direct toxic effect of heroin, cocaine abuse, MDMA or volatile solutes use. Glomerulonephritis and nephrotic syndrome can be presented as focal glomerulosclerosis in heroin nephropathy and cocaine abuse, post infectious or associated to HBV, HIV or HCV infection nephropathy. Chronic parenteral drug users may develop secondary amyloidosis. Finally, drug abuse can lead to ESRD mainly by causing deterioration of preexisting renal disease at a higher rate. In conclusion, significant alterations have been observed in the kidneys’ structure since they participate in drug metabolism. There is lack of retrospective studies and information has been given from case reports. The continuation of substance abuse after the appearance of renal damage increases the risk of permanent renal disease and consequently may lead to end stage renal failure.