Acute kidney injury associated with smoking synthetic cannabinoid

G. L. Buser, R. R. Gerona, B (Zane) Horowitz, K. P. Vian, Megan Troxell, Robert Hendrickson, Donald Houghton, David Rozansky, S. W. Su, R. F. Leman

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Context and objectives. Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synthetic cannabinoids, review the toxicologic and public health investigation of the cluster, and describe clinical implications of the cluster investigation. Materials and methods. Case series of nine patients affected by the toxicologic syndrome in Oregon and southwestern Washington during May-October 2012. Cases were defined as acute kidney injury (creatinine > 1.3 mg/dL) among persons aged 13-40 years without known renal disease who reported smoking synthetic cannabinoids. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry to test clinical and product specimens for synthetic cannabinoids, their metabolites, and known nephrotoxins. Public health alerts informed clinicians, law enforcement, and the community about the cluster and the need to be alert for toxidromes associated with emerging drugs of abuse. Results. Patients were males aged 15-27 years (median, 18 years), with intense nausea and flank or abdominal pain, and included two sets of siblings. Peak creatinine levels were 2.6-17.7 mg/dL (median, 6.6 mg/dL). All patients were hospitalized; one required dialysis; none died. No alternate causes of acute kidney injury or nephrotoxins were identified. Patients reported easily purchasing synthetic cannabinoids at convenience, tobacco, and adult bookstores. One clinical and 2 product samples contained evidence of a novel synthetic cannabinoid, XLR-11 ([1-(5-fluoropentyl) -1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone). Discussion and conclusion. Whether caused by direct toxicity, genetic predisposition, or an as-yet unidentified nephrotoxin, this association between synthetic cannabinoid exposure and acute kidney injury reinforces the need for vigilance to detect new toxicologic syndromes associated with emerging drugs of abuse. Liquid chromatography and time-of-flight mass spectrometry are useful tools in determining the active ingredients in these evolving products and evaluating them for toxic contaminants.

Original languageEnglish (US)
Pages (from-to)664-673
Number of pages10
JournalClinical Toxicology
Volume52
Issue number7
DOIs
StatePublished - 2014

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Cannabinoids
Acute Kidney Injury
Smoking
Street Drugs
Liquid chromatography
Public health
Liquid Chromatography
Mass spectrometry
Mass Spectrometry
Creatinine
Public Health
Flank Pain
Law Enforcement
Epidemiology
Sympathomimetics
Dialysis
Tobacco
Poisons
Health risks
Law enforcement

Keywords

  • Electronspray ionization
  • Epidemiology
  • Mass
  • Public health
  • Spectrometry
  • Substance-related disorders

ASJC Scopus subject areas

  • Toxicology

Cite this

Acute kidney injury associated with smoking synthetic cannabinoid. / Buser, G. L.; Gerona, R. R.; Horowitz, B (Zane); Vian, K. P.; Troxell, Megan; Hendrickson, Robert; Houghton, Donald; Rozansky, David; Su, S. W.; Leman, R. F.

In: Clinical Toxicology, Vol. 52, No. 7, 2014, p. 664-673.

Research output: Contribution to journalArticle

Buser, G. L. ; Gerona, R. R. ; Horowitz, B (Zane) ; Vian, K. P. ; Troxell, Megan ; Hendrickson, Robert ; Houghton, Donald ; Rozansky, David ; Su, S. W. ; Leman, R. F. / Acute kidney injury associated with smoking synthetic cannabinoid. In: Clinical Toxicology. 2014 ; Vol. 52, No. 7. pp. 664-673.
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AU - Gerona, R. R.

AU - Horowitz, B (Zane)

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AU - Troxell, Megan

AU - Hendrickson, Robert

AU - Houghton, Donald

AU - Rozansky, David

AU - Su, S. W.

AU - Leman, R. F.

PY - 2014

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N2 - Context and objectives. Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synthetic cannabinoids, review the toxicologic and public health investigation of the cluster, and describe clinical implications of the cluster investigation. Materials and methods. Case series of nine patients affected by the toxicologic syndrome in Oregon and southwestern Washington during May-October 2012. Cases were defined as acute kidney injury (creatinine > 1.3 mg/dL) among persons aged 13-40 years without known renal disease who reported smoking synthetic cannabinoids. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry to test clinical and product specimens for synthetic cannabinoids, their metabolites, and known nephrotoxins. Public health alerts informed clinicians, law enforcement, and the community about the cluster and the need to be alert for toxidromes associated with emerging drugs of abuse. Results. Patients were males aged 15-27 years (median, 18 years), with intense nausea and flank or abdominal pain, and included two sets of siblings. Peak creatinine levels were 2.6-17.7 mg/dL (median, 6.6 mg/dL). All patients were hospitalized; one required dialysis; none died. No alternate causes of acute kidney injury or nephrotoxins were identified. Patients reported easily purchasing synthetic cannabinoids at convenience, tobacco, and adult bookstores. One clinical and 2 product samples contained evidence of a novel synthetic cannabinoid, XLR-11 ([1-(5-fluoropentyl) -1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone). Discussion and conclusion. Whether caused by direct toxicity, genetic predisposition, or an as-yet unidentified nephrotoxin, this association between synthetic cannabinoid exposure and acute kidney injury reinforces the need for vigilance to detect new toxicologic syndromes associated with emerging drugs of abuse. Liquid chromatography and time-of-flight mass spectrometry are useful tools in determining the active ingredients in these evolving products and evaluating them for toxic contaminants.

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KW - Epidemiology

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KW - Public health

KW - Spectrometry

KW - Substance-related disorders

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