Zarifi Ceyda, Vyas Shuchi
Internal Medicine Resident at the University of California, Riverside. She completed her medical training at the Western University of Health Sciences in Pomona, CA.
Nephrologist for the Southern California Permanente Medical Group in Riverside. She completed her Nephrology fellowship at Northwestern University in Chicago, IL.
Perm J. 2017;21. doi: 10.7812/TPP/16-160.
Spice is a synthetic cannabinoid that is readily available for purchase in smoke shops at relatively low cost. Spice is not detectable upon routine drug screening, making it an increasingly popular new street drug.
A 21-year-old man presented with new-onset seizures. During the next 2 days, he developed uncontrollable hypertension, agitation, respiratory failure requiring intubation, pulmonary hypertension, and acute kidney injury (AKI) with a maximum blood urea nitrogen/creatinine level of 54/7.90 mg/dL. A complete renal workup was negative, but his urine sediment revealed granular casts. A discussion with family and friends revealed that this patient had smoked Spice during the last month. His renal function started to improve with supportive therapy, and his AKI resolved by the time of discharge without renal replacement therapy.
Spice differs from marijuana because it is a cannabinoid receptor type 1 and 2 agonist. The pathologic mechanism of AKI remains unclear, but the condition likely is attributable to acute tubular necrosis or acute interstitial nephritis, as proven by biopsies performed in previous case series. It is important to raise awareness that a new Spice strain that may be circulating in the Southern California Inland Empire can endanger young users who may develop seizures, respiratory failure, and AKI.
Spice是一种合成大麻素，在烟店中很容易以相对较低的成本买到。常规药物筛查无法检测出Spice，这使其成为一种越来越受欢迎的新型街头毒品。
一名21岁男性出现新发癫痫发作。在接下来的2天里，他出现了难以控制的高血压、躁动、需要插管的呼吸衰竭、肺动脉高压以及急性肾损伤（AKI），血尿素氮/肌酐水平最高达到54/7.90mg/dL。全面的肾脏检查结果为阴性，但他的尿沉渣显示有颗粒管型。与家人和朋友的交谈发现，该患者在过去一个月内吸食过Spice。经过支持治疗，他的肾功能开始改善，出院时急性肾损伤已痊愈，无需进行肾脏替代治疗。
Spice与大麻不同，因为它是一种1型和2型大麻素受体激动剂。急性肾损伤的病理机制尚不清楚，但这种情况可能归因于急性肾小管坏死或急性间质性肾炎，正如之前病例系列中的活检所证实的那样。重要的是要提高认识，即一种可能在南加州内陆帝国流通的新型Spice毒株可能会危及年轻使用者，他们可能会出现癫痫发作、呼吸衰竭和急性肾损伤。
