Rhabdomyolysis and acute renal failure resulting from alcohol and drug abuse

Rhabdomyolysis is a common cause of acute renal failure (ARF) associated wi th drug misuse. Abuse of the gel formulation of temazepam has been a partic ular problem in the West of Scotland. We performed a retrospective review o f dialysis-dependent ARF from rhabdomyolysis and drug misuse in the West of Scotland, 1986-1997. We identified 76 patients, of whom 87% were male. Sev enteen cases occurred in the first 6 years, compared with 59 in the subsequ ent 6 years. Median age was 32. Thirty cases followed intravenous drug misu se, 46 followed oral drug misuse. The substances most frequently misused we re alcohol (54%), heroin (24%) and parenteral temazepam (17%). The temazepa m cases all followed the introduction of the gel formulation. Three out of 4 patients requiring limb amputation had injected temazepam. Of intravenous drug misusers tested, 72% were hepatitis-C-positive. Some 43% of patients had deprivation scores in the worst category. ARF due to rhabdomyolysis fro m substance misuse is increasing in our area. Alcohol is frequently respons ible. The introduction of the gel formulation of temazepam has contributed to the increase. Those at risk in this study were young, male, had a high i ncidence of hepatitis C and lived in the most deprived areas.