Heroin overdose and myoglobinuric acute renal failure

Background: Heroin abuse is an increasing problem in Australia. In our hosp itals we have noted an apparent increase in drug-related admissions. In thi s study we aimed to examine the incidence of renal failure due to heroin-re lated rhabdomyolysis and to determine any predisposing factors to the requi rement for dialysis in these patients. Patients and methods: We identified a group of 27 patients who developed renal failure after recent intravenous heroin use. There was a significant rise in the incidence during 1997 - 19 98 compared with the previous seven years (p < 0.05). Results: Rhabdomyolys is was the likely cause of renal failure in all cases. Eight patients requi red dialysis for an average of 14 days (range 3 - 26). Patients who require d dialysis had a higher admission creatine kinase (115 x 10(3) U/l (1 - 316 ), median (range), versus 9 x 10(3) (0 - 91), p < 0.05), a higher admission creatinine (3.8 mg/dl (2.1 - 6.7) versus 2.4 (1.4 - 8.1), p < 0.05), a hig her peak creatinine kinase (129 x 10(3) U/l (2 - 316) versus 22 x 10(3) (3 - 197), p < 0.05), a lower urine output in the initial 24 hours (0.91/24 hr s (0.1 - 1.5) versus 3.9 (1.0 - 11.1), p < 0.005) and a longer length of ho spitalization (37 days (17 - 112) versus 12 (5 - 87), p < 0.05). No patient died and all patients had independent renal function at last review. The m ajority of patients had significant comorbidities. The incidence of serolog ical evidence of exposure to blood-borne viruses was HIV 5% (n = 1), hepati tis B 10% (n = 2) and hepatitis C 74% (n = 17) of patients tested. Pneumoni a occurred in 52% (n = 14) and 26% (n = 7) developed respiratory failure re quiring intubation. 22% (n = 6) developed a compartment syndrome requiring fasciotomy and 37% (n = 10)had significant residual limb weakness at discha rge. Conclusion: There is an increase in patients admitted with rhabdomyoly sis-induced renal failure associated with heroin use in our hospitals. We f ound a varied approach to an increasing clinical problem and suggest that a consistent investigative and therapeutic approach be introduced. Although renal recovery can be expected, long-term disability may occur due to poten tial serious complications.