Methamphetamine (N-methylamphetamine)-induced renal disease: underevaluated cause of end-stage renal disease (ESRD)

• Published in: BMJ case reports Vol. 12; no. 9; p. e230288
• Main Authors: Baradhi, Krishna M, Pathireddy, Samata, Bose, Subhasish, Aeddula, Narothama Reddy
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-09-2019; BMJ Publishing Group
• Series: Case report
• Subjects: Acidosis; Acidosis - complications; Adult; Alcohol; Amphetamines; Antihypertensives; Biopsy; Cardiomyopathy; Case reports; Disease Progression; Dopamine; Drug abuse; Ecstasy; Family medical history; Hemodialysis; Hepatitis; Humans; Hydration; Hypertension; Hypertension - complications; Hyperthermia; Kidney diseases; Kidney Failure, Chronic - chemically induced; Kidney Failure, Chronic - pathology; Laboratories; Lupus; Male; Methamphetamine; Methamphetamine - adverse effects; Public health; Substance Abuse, Intravenous; Substance Abuse, Oral; Ultrasonic imaging; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; Urine; drug misuse (including addiction); chronic renal failure; public health; unwanted effects / adverse reactions
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-230288

A 26-year-old Caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which showed vascular and glomerular changes consistent with thrombotic microangiopathic injury and advanced glomerulosclerosis. He was treated with antihypertensives and required haemodialysis. He admitted using ‘crystal meth’ regularly for many years, which is likely responsible for his renal failure. We present the case to illustrate methamphetamine-induced renal disease leading to end-stage renal disease and to bring awareness among practising clinicians, ancillary healthcare workers and public health professionals of this often undervalued cause of renal failure, which can be prevented.