Acute Kidney Injury Associated with Synthetic Cannabinoid Use—Oregon, 2012

Buser, Genevieve

BACKGROUND: Synthetic cannabinoids are illegal drugs that cause adverse neurologic and sympathomimetic effects. During 2010, synthetic cannabinoids resulted in >11,000 US emergency department visits. Synthetic cannabinoids are increasingly popular; nationally, 11.4% of high school seniors reported smoking them during the previous 12 months. In August 2012, clinicians reported acute kidney injury (AKI) in a youth after he smoked a synthetic cannabinoid. Oregon’s Public Health Division and Poison Center investigated to determine the problem’s scope.

METHODS: Cases were defined as AKI (creatinine >1.3 mg/dL) treated in Oregon since April 2012 among persons without known renal disease and aged 13–40 years who reported smoking synthetic cannabinoids. We queried poison centers, distributed health alerts, contacted nephrologists, and issued a press release. We interviewed patients, collected specimens, and abstracted medical records. Drug enforcement teams seized implicated products. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry (TOFMS) to test clinical and product specimens for synthetic cannabinoids and metabolites.

RESULTS: We identified nine cases with onset during April–October 2012. All patients were male, aged 15–27 (median: 18) years, who reported intense nausea and emesis, with and without abdominal pain. Peak creatinine levels were 2.6–17.7 (median: 6.6) mg/dL. All patients were hospitalized; one required dialysis; none died. Six patients completed interviews. They easily purchased synthetic cannabinoids at convenience, tobacco, and adult stores, believing them legal and safe. Two clinical and two product samples contained evidence of a novel synthetic cannabinoid, XLR-11.

CONCLUSIONS: Active case finding, investigation, and state-of-the-art toxicology testing identified a novel epidemiologic link between smoking synthetic cannabinoids and AKI. TOFMS analyses to identify other toxins and animal kidney models to elucidate nephrotoxic mechanisms are ongoing.