Cocaine-induced acute renal failure, hemolysis, and thrombocytopenia mimicking thrombotic thrombocytopenic purpura

Acute renal failure (ARF) can occur as a complication of cocaine abuse. We present a case of microangiopathic hemolytic anemia, ARF, and thrombocytope nia after inhalation of crack cocaine in a 38-year-old woman, Her renal fai lure ultimately required dialysis, She underwent renal biopsy because of pe rsistent renal failure, hematuria, and thrombocytopenia, The biopsy finding s consisted of thrombotic microangiopathy and glomerular ischemia, After tr eatment with fresh frozen plasma, her platelet count and bleeding resolved. The possible mechanisms involved in cocaine-induced thrombotic microangiop athy include: (1) endothelial injury, (2) vasoconstriction and/or impairmen t of vasodilatation, (3) procoagulant activity, and (4) antiplatelet activi ty. Although our patient survived after hemodialysis and transfusion of fre sh frozen plasma, she continued to have residual renal insufficiency. One m onth later, the patient again used cocaine and presented with worsening ARF , anemia, and thrombocytopenia, (C) 2000 by the National Kidney Foundation, inc.