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      Nefrotoxicidad por uso recreacional de drogas psicoactivas. Reporte de un caso Translated title: Nephrotoxicity after recreational drug use. Case report

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          Abstract

          El uso recreacional de drogas psicoactivas es una práctica generalizada en población de adultos jóvenes en el mundo. Existe evidencia de que los opioides y la cocaína producen toxicidad renal. La necrosis tubular aguda, rabdomiolisis y la glomerulonefritis focal segmentaria son las presentaciones más comunes. Reportamos un caso de daño renal agudo en un joven después del uso recreacional de alcohol, cocaína y opioides, cuyos hallazgos patológicos son descritos brevemente en la literatura.

          Translated abstract

          Recreational drug use is a widespread activity in the young adult population. Cocaine and opioids have well described mechanism for renal toxicity, they include local and systemic toxicity, acute tubular necrosis, rhabdomylolysis and focal segmental glomerulosclerosis are among the most common presentations. We report a case of acute kidney injury in a young man after the recreational use of alcohol, cocaine and opioids, the pathological findings are described and a brief review of the literature is presented.

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          Pathophysiology of acute kidney injury.

          David P Basile, Melissa Anderson, Timothy A. Sutton (2012)
          Acute kidney injury (AKI) is the leading cause of nephrology consultation and is associated with high mortality rates. The primary causes of AKI include ischemia, hypoxia, or nephrotoxicity. An underlying feature is a rapid decline in glomerular filtration rate (GFR) usually associated with decreases in renal blood flow. Inflammation represents an important additional component of AKI leading to the extension phase of injury, which may be associated with insensitivity to vasodilator therapy. It is suggested that targeting the extension phase represents an area potential of treatment with the greatest possible impact. The underlying basis of renal injury appears to be impaired energetics of the highly metabolically active nephron segments (i.e., proximal tubules and thick ascending limb) in the renal outer medulla, which can trigger conversion from transient hypoxia to intrinsic renal failure. Injury to kidney cells can be lethal or sublethal. Sublethal injury represents an important component in AKI, as it may profoundly influence GFR and renal blood flow. The nature of the recovery response is mediated by the degree to which sublethal cells can restore normal function and promote regeneration. The successful recovery from AKI depends on the degree to which these repair processes ensue and these may be compromised in elderly or chronic kidney disease (CKD) patients. Recent data suggest that AKI represents a potential link to CKD in surviving patients. Finally, earlier diagnosis of AKI represents an important area in treating patients with AKI that has spawned increased awareness of the potential that biomarkers of AKI may play in the future. © 2012 American Physiological Society. Compr Physiol 2:1303-1353, 2012.
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            Xenobiotic, bile acid, and cholesterol transporters: function and regulation.

            Curtis D. Klaassen, Lauren Aleksunes (2010)
            Transporters influence the disposition of chemicals within the body by participating in absorption, distribution, and elimination. Transporters of the solute carrier family (SLC) comprise a variety of proteins, including organic cation transporters (OCT) 1 to 3, organic cation/carnitine transporters (OCTN) 1 to 3, organic anion transporters (OAT) 1 to 7, various organic anion transporting polypeptide isoforms, sodium taurocholate cotransporting polypeptide, apical sodium-dependent bile acid transporter, peptide transporters (PEPT) 1 and 2, concentrative nucleoside transporters (CNT) 1 to 3, equilibrative nucleoside transporter (ENT) 1 to 3, and multidrug and toxin extrusion transporters (MATE) 1 and 2, which mediate the uptake (except MATEs) of organic anions and cations as well as peptides and nucleosides. Efflux transporters of the ATP-binding cassette superfamily, such as ATP-binding cassette transporter A1 (ABCA1), multidrug resistance proteins (MDR) 1 and 2, bile salt export pump, multidrug resistance-associated proteins (MRP) 1 to 9, breast cancer resistance protein, and ATP-binding cassette subfamily G members 5 and 8, are responsible for the unidirectional export of endogenous and exogenous substances. Other efflux transporters [ATPase copper-transporting beta polypeptide (ATP7B) and ATPase class I type 8B member 1 (ATP8B1) as well as organic solute transporters (OST) alpha and beta] also play major roles in the transport of some endogenous chemicals across biological membranes. This review article provides a comprehensive overview of these transporters (both rodent and human) with regard to tissue distribution, subcellular localization, and substrate preferences. Because uptake and efflux transporters are expressed in multiple cell types, the roles of transporters in a variety of tissues, including the liver, kidneys, intestine, brain, heart, placenta, mammary glands, immune cells, and testes are discussed. Attention is also placed upon a variety of regulatory factors that influence transporter expression and function, including transcriptional activation and post-translational modifications as well as subcellular trafficking. Sex differences, ontogeny, and pharmacological and toxicological regulation of transporters are also addressed. Transporters are important transmembrane proteins that mediate the cellular entry and exit of a wide range of substrates throughout the body and thereby play important roles in human physiology, pharmacology, pathology, and toxicology.
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              Adulterants in illicit drugs: a review of empirical evidence.

              Qutub Syed, Lisa Jones, Mark Bellis … (2011)
              Widespread public perception is that illicit drugs contain substances that are a serious risk to health, even though adulterants are often not considered in clinical or forensic toxicology. This review attempts to present an evidence-based overview of adulterants in illicit drugs, and their associated toxicity. Adulterants are deliberately added to increase bulk, enhance or mimic a pharmacological effect, or to facilitate drug delivery. Those present unintentionally are as a result of poor manufacturing techniques. From the reports gathered, adulterants are predominantly substances which are readily available, commonly being caffeine, procaine, paracetamol, and sugars. These are likely to have minimal impact on users' health at low dosages. Other adulterants, particularly in injectable drugs, have the potential to cause serious health issues, but the quantities reported, such as strychnine in heroin, are not life-threatening. The most commonly identified bacterial contaminants identified are Bacillus and Clostridium species. When death or serious illness due to adulteration occurs, circulation of information is particularly vital, such as in the USA regarding heroin and cocaine adulterated with fentanyl, and in Scotland recently regarding anthrax contaminated heroin. The complex interactions of supply, demand, and control of illicit drugs have a tangible impact on their adulteration. Continuing vigilance and the circulation of information is, therefore, desirable as a public health issue. As part of that strategy, analyses performed for adulterants needs to be encouraged, which are considerably limited in number and scope at the moment. Copyright © 2010 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Journal ID (publisher-id): sun
                Title: Revista Salud Uninorte
                Abbreviated Title: Salud, Barranquilla
                Publisher: Fundación Universidad del Norte, División de Ciencias de la (Barranquilla, Atlantico, Colombia )
                ISSN (Print): 0120-5552
                ISSN (Electronic): 2011-7531
                Publication date (Print and electronic): May 2015
                Volume: 31
                Issue: 2
                Pages: 358-366
                Affiliations
                [01] Barranquilla orgnameClínica de la Costa Colombia
                [02] Barranquilla orgnameUniversidad del Norte Colombia
                [05] Barranquilla orgnameUniversidad del Norte Colombia
                [03] Barranquilla orgnameClínica de la Costa Colombia
                [04] Barranquilla orgnameUniversidad del Norte Colombia
                Article
                Publisher ID: S0120-55522015000200015 Publisher ID: S0120-5552(15)03100215
                SO-VID: 92d2d851-431b-4e5b-bb65-cb43f228dd91
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Date received : 09 November 2014
                Date accepted : 15 February 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 49, Pages: 9
                Product

                SciELO Colombia

                Categories
                Subject: Artículos revisión

                Keywords: falla renal,necrosis tubular,glomerulonephritis focal segmental,abuso de drogas,tubular necrosis,cocaína,cocaine,drug abuse,heroin,renal failure,glomerulonefritis focal segmentaria,heroína
                Data availability:
                Keywords: falla renal, necrosis tubular, glomerulonephritis focal segmental, abuso de drogas, tubular necrosis, cocaína, cocaine, drug abuse, heroin, renal failure, glomerulonefritis focal segmentaria, heroína

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