| dc.description.abstract | Cocaine abuse and intoxication is a global problem leading to
many medical complications that can result in significant morbidity
and mortality. Many lesions, including thrombotic microangiopathy,
can cause acute renal injury associated with cocaine use. We report
the case of a patient who developed thrombotic microangiopathy in
the context of cocaine intoxication. A 40-year-old man, with a history
of intermittent cocaine abuse, was transferred to the Department
of Nephrology at Aristide Le Dantec University Hospital in Dakar, for
the management of declining renal function in the context of acute
agitation. Physical examination showed a blood pressure of 160/100
mmHg, and proteinuria and haematuria each at three crosses in a
dipstick urinary test. Neurological examination found psychometric
agitation without localization. Cardiac, pulmonary, abdominal,
musculoskeletal and lymph node examinations were normal. Biological
investigations on admission revealed: mechanical haemolyticanaemia,
thrombocytopenia and serum creatinine at 3.8 mg/dl, blood urea at
182 mg/dl. The renal ultrasound showed normal kidney size but bad
differentiation. Kidney biopsy was performed and showed partial
collapse of the tuft in ten glomeruli, three of which contained fibrin
thrombi with sub-occlusive mucoidendothelitis and fibrinoid necrosis
of arterioles. The diagnosis of thrombotic microangiopathy revealed
by a haemolytic and uraemic syndrome in a cocaine intoxication
context was confirmed. Evolution was favourable after blood pressure
control using combined amlodipine and ramipril at full dose, and the
transfusion of three units of red blood cellsand fresh frozen plasma. The
patient is currently being monitored as a nephrology outpatient. At his
last check up, he had a good general condition and his GFR was 29
ml/min/1.73 m3. | en_US |
