Heroin overdose and myoglobinuric acute renal failure.

Background: Heroin abuse is an increasing problem in Australia. In our hospitals we have noted an apparent increase in drug-related admissions. In this study we aimed to examine the incidence of renal failure due to heroin-related rhabdomyolysis and to determine any predisposing factors to the requirement 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 - 1998 compared with the previous seven years (p < 0.05). Result(s): Rhabdomyolysis was the likely cause of renal failure in all cases. Eight patients required dialysis for an average of 14 days (range 3-26). Patients who required dialysis had a higher admission creatine kinase (115 x 103 U/l (1-316), median (range), versus 9 x 103 (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 higher peak creatinine kinase (129 x 103 U/l (2-316) versus 22 x 103 (3-197), p < 0.05), a lower urine output in the initial 24 hours (0.9 1/24 hrs (0.1 -1.5) versus 3.9 (1.0-11.1), p < 0.005) and a longer length of hospitalization (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 majority of patients had significant comorbidities. The incidence of serological evidence of exposure to blood-borne viruses was HIV 5% (n = 1), hepatitis B 10% (n = 2) and hepatitis C 74% (n = 17) of patients tested. Pneumonia occurred in 52% (n=14) and 26% (n = 7) developed respiratory failure requiring intubation. 22% (n = 6) developed a compartment syndrome requiring fasciotomy and 37% (n = 10) had significant residual limb weakness at discharge. Conclusion(s): There is an increase in patients admitted with rhabdomyolysis-induced renal failure associated with heroin use in our hospitals. We found a varied approach to an increasing clinical problem and suggest that