Case series: 9 patients with acute kidney injury after smoking a synthetic cannabinoid
August 21, 2014, 11:13 pm
Acute kidney injury associated with smoking synthetic cannabinoid. Buser GL et a. Clin Toxicol 2014;52:663-673.
In the summer of 2012, two patients presented to emergency departments in western Oregon complaining of nausea, vomiting and flank pain that started shortly after smoking a synthetic cannabinoid product. Both patients had elevated serum creatinine levels and hypertension. Renal biopsy revealed acute tubular injury with inflammation in both patients. Extensive work-up did not reveal any other possible cause of renal disease.
A public health investigation identified seven other patients in the region who presented with acute kidney injury (AKI) within 2 weeks of smoking a synthetic cannabinoid. Some key features of these cases include:
- Exposure to several synthetic cannabinoid products, including “Clown Loyal,” Johnny Clearwater” (caramel corn), “Lava,” and “Orgazmo” (pineapple).
- The synthetic cannabinoid XLR-11 was detected in each of 2 involved products that were tested, as well as in clinical specimens from one of five patients tested.
- All patients recovered, although received a short course of hemodialysis.
[ADDENDUM 8/22/14]: The authors wisely point out that the detection of XLR-11 is some specimens does not prove that it caused the AKI — hence the word “associated” in the title. Also, the failure to identify the chemical in four of five patients tested for it might just mean that the specimens were drawn after XLR-11 was eliminated. ]
This article is a very complete and finely done description both of the clinical syndrome of AKI associated with use of synthetic cannabinoids, and the related public health investigation. [HT @DougBorys]