1. MORNING REPORT
Patrick Sandiford, 2/10/2014

2. COCAINE
• Cocaine (benzoyl methylecgonine) is available in two forms: cocaine
hydrochloride and alkaloid cocaine (freebase/crack)
• Plasma half life is 45-90 minutes
• Low renal clearance, elimination predominantly controlled by
biotransformation through plasma and liver cholinesterases. These produce
benzoyl and ethyl methylecgonine which are water-soluble metabolites
excreted in urine.
• Common major toxic effects: MI, CVA, mesenteric ischemia, placental
infarcts

3. RENAL INFARCTION
• Common risk factors for renal infarction include valvular heart disease,
atheroembolic events, hypercoagulopathy, systemic vasculitis, blunt trauma,
collagen vascular disorders, endocarditis.
• Pathophysiology of Renal Infarction:
• Affect on vascular reactivity and renal hemodynamics
• Inability to inhibit update of catecholamines into synapse
• Inhibition of re-uptake of NE in sympathetically innervated tissues and
subsequent release of NE and Epi from adrenal medulla.
• Prothrombotic
• Most cases of renal infarction involve right kidney (longer artery, more prone to
ischemia)
• Although no definitive model yet

4. RENAL INFARCTION
• Diagnosis of exclusion, many remain idiopathic
• No clear management – vasospasm vs. thrombosis or both
• Most proceed with conservative approach

5. REFERENCES
• S. BEMANIAN ET. AL, COCAINE-INDUCED RENAL INFARCTION: REPORT OF A
CASE AND REVIEW OF THE LITERATURE. BMC NEPHROLOGY 2005, 6:10, 22
SEPTEMBER 2005
• UPTODATE.COM

6. REFERENCES
• S. BEMANIAN ET. AL, COCAINE-INDUCED RENAL INFARCTION: REPORT OF A
CASE AND REVIEW OF THE LITERATURE. BMC NEPHROLOGY 2005, 6:10, 22
SEPTEMBER 2005
• UPTODATE.COM