Methamphetamine intoxication and acute kidney injury: A prospective observational case series

Aim The effects of methamphetamine intoxication on the kidney are not well reported. We aimed to investigate acute kidney injury (AKI) associated with methamphetamine intoxication, in particular its severity, duration and association with rhabdomyolysis. Methods This is a prospective observational series of methamphetamine‐intoxicated patients presenting to an Emergency Department. Patients self‐reporting recent methamphetamine use, with a positive urine drug screen and an elevated creatinine, were eligible for the study. Urinary neutrophil gelatinase‐associated lipocalin (NGAL) was measured, and serum creatinine, creatine kinase and cystatin C concentrations were performed on arrival and at several time points until discharge from hospital. Demographic and clinical data were obtained from the medical records. Results There were 634 presentations with methamphetamine intoxication over a 10‐month period, with 73/595(12%) cases having an elevated serum creatinine concentration on arrival. Fifty presentations in 48 patients were included in the study. Most patients (85%) were male with a median age of 32 years. The median serum creatinine concentration on presentation was 125 μmol/L (IQR:113‐135 μmol/L) with 45 (90%) presentations meeting diagnostic criteria for AKI. Concurrent rhabdomyolysis occurred in 22 (44%) presentations with a median CK of 2695 U/L (IQR:1598‐5060 U/L). Cystatin C was elevated (> 0.98 mg/L) in 18 cases. An elevated NGAL concentration (>150 μg/L) was present in five (10%) cases. No patients required dialysis. The median length of stay was 19 hours (IQR 14‐24 hours). Conclusion AKI is common in methamphetamine intoxication. The kidney injury is relatively mild and short‐lived, resolving with crystalloid therapy. SUMMARY AT A GLANCE One of the largest case series of metamphetamine associated AKI showing that AKI though commonly observed in metamphetamine abuse is often of low severity.