MMWR: synthetic pot suspected in cases of kidney failure

February 14, 2013, 7:05 pm

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Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012. MMWR 2013 Feb 15;62:93-98.

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About a year ago, TPR posted that several cases of acute renal failure following the use of synthetic cannabinoids had been reported in Wyoming. After this, the story seemed to drop off the map, and we were unable to obtain any additional information despite several calls to the Wyoming Department of Health.

The current issue of MMWR contains at important update. Following an alert issued after the 4 Wyoming cases were reported, 12 additional cases were detected in several states: Oregon (6 cases), New York (2), Oklahoma (2), Rhode Island and Kansas (1 each). The most common presenting symptoms were nausea and vomiting (15/16 cases) and abdominal, flank, and/or back pain (12 cases). The highest recorded serum creatinine was 21.0 mg/dL (normal 0.6-1.3 mg/dL). Renal biopsy in 8 patients revealed acute tubular injury (6) and acute interstitial nephritis (3). Although all patients recovered, 5 patients required hemodialysis.

Synthetic cannabinoids (SC) products associated with these cases included those labelled with the names “Phantom Wicked Dreams”, “Mr. Happy”, “clown Loyal”, and “Lava”. Toxicological analysis of products consumed and biological specimens were possible in 7 cases. Although no single SC compound was identified in all these cases, six of seven had biological and/or product specimens positive for XLR-11 or its metabolites. This compound is a fluorinated derivative of UR-144, a drug that has been previously identified in SC products sold over the internet. The authors point out that it is not clear whether or not XLR-11 caused the kidney injury in these cases, or was just commonly found in SC products at the time they were reported.

The authors conclude that:

Physicians caring for otherwise healthy adolescents and young adults with unexplained AKI [acute kidney injury] should inquire about SC use, and cases of suspected SC poisoning should be reported to both the regional poison center and the appropriate state health department.

Related posts:

Blueberry ‘spice” in Wyoming linked to cases of renal failure

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