Acute renal failure associated with cocaine and alcohol abuse

A broad spectrum of renal diseases is reported in cocaine abuse subjects, nevertheless the pathogenesis of the acute temporary renal failure is unclear. Cocaine may induce rhabdomyolysis and/or renal vasoconstriction being a powerful sympathomimethic drug and in turn renal failure. A 20-year-old man developed a reversible acute renal failure following an episode of cocaine and alcohol abuse. He was admitted for oliguria, swelling, pain and reduced strength in the left lower limb. The increase of serum creatinine and muscular enzymes and the presence of urinary granular and jaline casts were suggestive of rhabdomyolysis and renal damage. The clinical picture completely recovered after 15 days from the onset. We believe that an intense arterial vasoconstriction was the more probable mechanism of rhabdomyolysis and acute renal failure in this patient both because renal function recovered 5 days after forced diuresis and because biochemical indices of renal activity were always normal during 4 months after hospital discharge. Moreover, the report that the contemporary ingestion of alcohol and cocaine has an additive and synergistic effect causing the hepatic production of cocaethylene, a metabolite able to increase the systemic toxic effects of cocaine, may support our hypothesis.