Interstitial nephritis amphetamine

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

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]. 

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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