Acute renal failure amphetamine

Both acid and alkaline manipulation of urine applies the principle of ion-trapping in the renal tubules. However, acid diuresis is not advocated because of the risk of developing myoglobinuria and acute renal failure. The intent of modifying the urine pH toward an acidic side is to promote the excretion of drugs with an alkaline pKa such as phencyclidine or amphetamine. 

Foley RJ, Kapatkin K, Verani R, Weinman EJ. Amphetamine-induced acute renal failure. South Med J 1984 77 258-259. 

Amphetamines are sympathomimeticamines with central nervous system stimulatory activity. They may induce a number of patterns of renal damage including rhabdomyolysis related acute renal failure, acute interstitial nephritis, and an angiitis resembling polyarteritis nodosa. 

Amphetamines have also been associated with a syndrome of acute renal failure and rhabdomyolysis. 

Tenamfetamine ( ecstasy, MDMA methylenedioxymethamphetamine) is structurally related to mescaline as well as to amphetamine. It was originally patented in 1914 as an appetite suppressant and has recently achieved widespread popularity as a dance drug at rave parties (where it is deemed necessary to keep pace with the beat and duration of the music popular names reflect the appearance of the tablets and capsules and include White Dove, White Burger, Red and Black, Denis the Menace). Tenamfetamine stimulates central and peripheral a-and p-adrenoceptors thus the pharmacological effects are compounded by those of physical exertion, dehydration and heat. In susceptible individuals (poor metabolisers who exhibit the CYP450 2D6 polymorphism) a severe and fatal idiosyncratic reaction may occur with fulminant hyperthermia, convulsioirs, disseminated intravascular coagulation, rhabdomyolysis, and acute renal and hepatic failure. Treatment includes activated charcoal, diazepam for convulsions, P-blockade (atenolol) for tachycardia, a-blockade (phentolamine) for hypertension, and dantrolene if the rectal temperature exceeds 39°C. 

Amphetamines have also been associated with a syndrome of acute kidney injury and rhabdomyolysis. Several series have described patients following intravenous injection of methamphetamine or phenmetrazine who presented with hyperactivity, fever, chills, sweats, abdominal cramps, diarrhea, and hypotension [177,178]. The patients have developed acute kidney injury which is usually oliguric and associated with classic rhabdomyolysis, similar to cases of cocaine-induced rhabdomyolysis. Several patients have had disseminated intravascular coagulation and liver function abnormalities as well. Methamphetamine abuse has also been associated with accelerated hypertension, unexplained chronic renal failure, acute lead poisoning (a common reagent used in its production utilizes lead acetate) and at least one case of biopsy proven interstitial nephritis the latter patient responded to intravenous corticosteroids but whether the nephritis was truly due to amphetamines remains unproven [179]. 

The effects of amphetamines on the kidney are mainly acute tubular necrosis on the basis of rhabdomyolysis (with myoglobinuria) and a disseminated intravascular coagulopathy. But, malignant hypertension and the resultant effects on the kidneys, must always be a consideration in the differential diagnosis of renal failure [45-50]. These effects are likely to be chronic and irreversible. Bingham et al reported a case of necrotising vasculopathy after the ingestion of... 

At least one case of acute interstitial nephritis has been attributed to amphetamine use [163]. This amphetamine abuser presented with acute nonoliguiic renal failure, large kidneys by ultrasonography, and microhematuria. The biopsy revealed interstitial edema and focal infiltrates of mononuclear cells and eosinophils with only patchy tubular degeneration. There was no evidence for rhabdomyolysis and the urine was negative for myoglobin. Although he required temporary hemodialytic support, renal function returned to normal after treatment with intravenous corticosteroids. The mechanism of this reaction remains unclear and its true relation to amphetamine abuse remains unproven. 

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