Acharya Ratna, Zeng Xu, Upadhyay Kiran
Department of Pediatrics.
Division of Anatomic Pathology, Department of Pathology, and.
Clin Nephrol Case Stud. 2023 Mar 27;11:55-60. doi: 10.5414/CNCS111063. eCollection 2023.
Synthetic cannabinoid (SCB) usage among children is a rapidly emerging public health concern in the United States. Acute kidney injury (AKI) is an uncommon manifestation of SCB usage, with acute tubular necrosis (ATN) as the predominant histology. Here we describe a 16-year-old adolescent who sustained severe non-oliguric AKI in association with SCB usage. Emesis, right flank pain, and hypertension were the presenting clinical features. There was no uveitis, skin rash, joint pains, or eosinophilia. Urinalysis showed absence of proteinuria or hematuria. Urine toxicology was negative. Renal sonogram showed bilateral echogenic kidneys. Renal biopsy demonstrated severe acute interstitial nephritis (AIN), mild tubulitis, and absence of ATN. AIN responded with pulse steroid followed by oral steroid. Renal replacement therapy was not required. Although the exact pathophysiology of SCB-associated AIN is not known, immune response elicited by the renal tubulointerstitial cells against the antigens present in the SCB is the most likely mechanism. A high index of suspicion for SCB-induced AKI is necessary in adolescents who present with AKI of unclear etiology.
在美国，儿童使用合成大麻素（SCB）是一个迅速出现的公共卫生问题。急性肾损伤（AKI）是SCB使用的一种不常见表现，主要组织学类型为急性肾小管坏死（ATN）。在此，我们描述一名16岁青少年，其因使用SCB而发生严重的非少尿型AKI。呕吐、右侧胁腹疼痛和高血压是其主要临床特征。无葡萄膜炎、皮疹、关节疼痛或嗜酸性粒细胞增多。尿液分析显示无蛋白尿或血尿。尿液毒理学检查为阴性。肾脏超声显示双侧肾脏回声增强。肾活检显示严重急性间质性肾炎（AIN）、轻度肾小管炎，无ATN。AIN经脉冲类固醇治疗后口服类固醇治疗有效。无需肾脏替代治疗。虽然SCB相关AIN的确切病理生理学尚不清楚，但肾小管间质细胞针对SCB中存在的抗原引发的免疫反应是最可能的机制。对于病因不明的AKI青少年，必须高度怀疑SCB诱导的AKI。
