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STEVE ELLIOTT

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For the first time in medical literature, cases of acute kidney injury directly linked with the use of products like “Spice” and “K2” have been reported. (The term you’ll see in the mainstream press is “synthetic marijuana,” but make no mistake about it — this chemical garbage has nothing to do with safe, non-toxic cannabis. The synthetic cannabinoids found in them are not found in marijuana).

Nephrologists at the University of Alabama at Birmingham (UAB) reported the case studies online in the Clinical Journal of the American Society of Nephrology and the article will appear in the March 2013 print edition of the journal, according to a UAB press release written by Jennifer Lollar.

The researchers report that nephrotoxicity — the poisonous effect of a substance on the kidneys — from designer drugs such as Spice or K2, which supposedly mimic the effects of marijuana, but are human-made chemicals, should be considered when a patient has acute kidney injury and no other evident cause.

This is especially true for young adults with negative urine screens, according to the paper’s senior author, Denyse Thornley-Brown, M.D., associate professor in the UAB Division of Nephrology.

Denyse Thornley-Brown, MD, UAB School of Medicine:  “Cases of acute coronary syndrome associated with synthetic marijuana use have been reported, but our publication is the first to associate use with acute kidney injury"
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Denyse Thornley-Brown, MD, UAB School of Medicine:
“Cases of acute coronary syndrome associated with synthetic marijuana use have been reported, but our publication is the first to associate use with acute kidney injury”

The use of “synthetic marijuana” has increased significantly over the past few years, according to Thornley-Brown, mostly among young adults who are subject to being piss-tested. The substances usually cost around $20 a gram.

Thornley-Brown and her colleagues outline the cases of four different, previously healthy young men whose acute kidney injuries were linked to ingestion of designer drugs popularly mis-labeled “synthetic marijuana.” All the patients were residents of the same northeast Alabama community, and all showed up at UAB or community hospitals within a nine-week period, showing symptoms of nausea, vomiting and abdominal pain after using Spice or K2.

“Cases of acute coronary syndrome associated with synthetic marijuana use have been reported, but our publication is the first to associate use with acute kidney injury,” said Gaurav Jain, M.D., coauthor of the study. “Tachycardia and seizures have also been reported with synthetic cannabinoids.”

Three of the patients had acute kidney injury marked by the excretion of abnormally small amounts of urine, known as asoliguric acute kidney injury, and the fourth had a decreased effective blood flow to the kidney, known as prerenal acute kidney injury. Three of the patients underwent a kidney biopsy which showed acute tubular necrosis, the death of cells that form the minute canals in the kidney that secret, reabsorb, collecte and transport urine.

Left untreated, this can cause the kidneys to shut down; in these four cases, the patients recovered kidney function, and none required dialysis.

Due to the small number of patients, the inability to get a sample of the designer drugs involved and the patients’ serum and urine samples being discarded by the time of the investigation, the scientists found it difficult to definitely argue that the drugs caused the kidney injuries.

But, according to Jain, given that “synthetic marijuana” preparations involve several additives, the causative agent could have been an additive rather than the synthetic cannabinoid itself.

“There is very little information regarding the ingredients in synthetic cannabinoids that are sold on the streets, although it is known that additional compounds are added to the preparations,” Jain said. “It is very likely that a possible nephrotoxin adulterated the preparation used by our patients.”

The authors recommend that doctors inquire about the use of designer drugs when evaluating patients with acute kidney injury, especially when the cause is unknown and the urinalysis is negative.

Jain said that people should avoid these designer drugs, since they have potentially life-threatening side effects.

“If they don’t get to a physician in time, the damage to their kidneys could be permanent, and they could end up on dialysis,” Jain said.

 

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