title: Nephrotoxic effects of common and emerging drugs of abuse.
abstract: The kidneys can be injured in diverse ways by many drugs, both legal and illegal. Novel associations and descriptions of nephrotoxic effects of common and emerging drugs of abuse have appeared over the past several years. Anabolic androgenic steroids, illicitly used by athletes and others for decades to increase muscle mass and decrease body fat, are emerging as podocyte toxins given recent descriptions of severe forms of FSGS in long-term abusers. Synthetic cannabinoids, a new group of compounds with marijuana-like effects, recently became popular as recreational drugs and have been associated with an atypical form of AKI. 3,4-Methylenedioxymethamphetamine, commonly known as ecstasy, is a widely used synthetic recreational drug with mood-enhancing properties and a constellation of toxicities that can result in death. These toxic effects include hyperthermia, hypotonic hyponatremia due to its arginine vasopressin secretagogue-like effects, rhabdomyolysis, and cardiovascular collapse. Cocaine, a serotonin-norepinephrine-dopamine reuptake inhibitor that serves as an illegal stimulant, appetite suppressant, and anesthetic, also causes vasoconstriction and rhabdomyolysis. Recent adulteration of much of the world's supply of cocaine with levamisole, an antihelminthic agent with attributes similar to but distinct from those of cocaine, appears to have spawned a new type of ANCA-associated systemic vasculitis. This review discusses the nephrotoxic effects of these common and emerging drugs of abuse, of which both community and health care providers should become aware given their widespread abuse. Future investigation into pathogenetic mechanisms associated with these drugs is critical and may provide a window into ways to lessen and even prevent the nephrotoxic effects of these drugs of abuse and perhaps allow a deeper understanding of the nephrotoxicities themselves.
authors.affiliation: UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Nephrology, Department of Medicine, and Vasculitis and Glomerulonephritis Clinic, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts;
authors.forename: William F
authors.initials: WF
authors.lastname: Pendergraft
authors.affiliation: Division of Renal Pathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York;
authors.forename: Leal C
authors.initials: LC
authors.lastname: Herlitz
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and.
authors.forename: Denyse
authors.initials: D
authors.lastname: Thornley-Brown
authors.affiliation: Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Rosner
authors.affiliation: Division of Nephrology, Department of Medicine, and Vasculitis and Glomerulonephritis Clinic, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts; jlniles@partners.org.
authors.forename: John L
authors.initials: JL
authors.lastname: Niles
mesh_terms: D045930:Anabolic Agents / Q000633:toxicity; D000728:Androgens / Q000633:toxicity*; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced; D002186:Cannabinoids / Q000633:toxicity*; D003042:Cocaine / Q000633:toxicity*; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D007978:Levamisole / Q000633:toxicity; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000378:metabolism / Q000633:toxicity*
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D002186:Cannabinoids; D013287:Illicit Drugs; D007978:Levamisole; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine
keywords: anabolic steroids; cocaine; drug nephrotoxicity; methamphetamines; synthetic cannabinoids