Thrombotic Microangiopathy and Acute Kidney Injury Associated With Intravenous Abuse of an Oral Extended-Release Formulation of Oxymorphone Hydrochloride: Kidney Biopsy Findings and Report of 3 Cases
Thrombotic Microangiopathy and Acute Kidney Injury Associated With Intravenous Abuse of an Oral Extended-Release Formulation of Oxymorphone Hydrochloride: Kidney Biopsy Findings and Report of 3 Cases
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DOI：
10.1053/j.ajkd.2014.01.015
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发表时间：
2014-06-01
影响因子：
13.2
通讯作者：
Larsen, Christopher P.
中科院分区：
文献类型：
--
作者：
Ambruzs, Josephine M.;Serrell, Paul B.;Larsen, Christopher P.
最近有报道和警告称，与静脉注射滥用口服处方麻醉剂有关的血栓性血小板减少性紫癜样疾病。口服缓释盐酸羟吗酮(Opana ER)是一种阿片激动剂，经过了防篡改的重新配制。然而，随后注射的片剂融化和溶解的情况继续发生。我们报告3例溶血性贫血和急性肾损伤与静脉滥用这种新配方的药物有关。3例患者均行肾活检，结果显示血栓性微血管病变，表现为严重的动脉和小动脉粘液样内膜水肿，并导致肾小球和肾小管缺血。3例均行血液透析，2例同时行治疗性血浆置换。早期随访显示肾脏预后不佳，尽管积极治疗，但仅部分恢复功能。这种新配方药物中与内皮损伤相关的特定成分尚不清楚。最重要的是，在治疗原因不明的血栓性血小板减少性紫癜样疾病时，需要高度的临床怀疑。(C)2014年，由国家肾脏基金会公司提供。
There have been recent reports and warnings of a thrombotic thrombocytopenic purpura-like illness associated with intravenous abuse of a prescription narcotic intended for oral use. Oral extended-release oxymorphone hydrochloride (Opana ER) is an opioid agonist that has undergone a tamper-resistant reformulation. However, instances of melting and dissolving tablets with subsequent injection continue to occur. We report 3 cases of hemolytic anemia and acute kidney injury associated with intravenous abuse of this reformulated drug. All 3 patients underwent native kidney biopsy that showed thrombotic microangiopathy characterized by severe arterial and arteriolar mucoid intimal edema with resultant glomerular and tubular ischemia. All 3 patients required hemodialysis and 2 also underwent therapeutic plasma exchange. Early follow-up suggests that kidney outcome is poor, with only partial recovery of function despite aggressive treatment. The specific component or components of this reformulated drug associated with endothelial injury is unknown. Most importantly, a high degree of clinical suspicion is needed when treating patients with a thrombotic thrombocytopenic purpura-like illness of unknown cause. (C) 2014 by the National Kidney Foundation, Inc.