Nature Reviews Nephrology | Review

Nephrotoxic effects of designer drugs: synthetic is not better!

Journal name:
Nature Reviews Nephrology
Volume:
10,
Pages:
314–324
Year published:
DOI:
doi:10.1038/nrneph.2014.44
Published online

Abstract

Designer drugs are synthetic, psychoactive substances with similar structures and activity to existing scheduled drugs or controlled chemical compounds. The use of these drugs is not generally considered illegal and they cannot be detected using standard toxicology tests—essentially they are considered to be 'legal highs'. Over the past several years, increasing numbers of designer drugs have become available. These drugs are classified as amphetamine derivatives, phenylpiperazine derivatives, synthetic cathinones, synthetic cannabinoids, phencyclidine derivatives and synthetic opioids. Although euphoria is the desired effect, neuropsychiatric and cardiac manifestations are frequently observed in individuals using these drugs at high doses or using drugs that are contaminated with other substances. Some designer drugs are also associated with adverse renal effects, including acute kidney injury from pigment nephropathy, acute tubular necrosis, obstructive nephropathy and hyponatraemia. The misuse of these drugs should be recognized and clinicians made aware of the potential for acute nephrotoxicity as the health burden of these compounds increases.

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  1. New designer drugs.
    Figure 1: New designer drugs.

    a | Numbers of newly identified designer drugs in 2009–2012. b | New designer drugs by subclass in 2012. N-methyl-D-aspartate receptor antagonists are classed as phencyclidine derivatives. Data adapted from United Nations Office on Drugs and Crime Report, 2013.11

  2. Prevalence of illicit drug use among high school students (aged 17-18 years) in the USA.
    Figure 2: Prevalence of illicit drug use among high school students (aged 17–18 years) in the USA.

    Data adapted from the United Nations Office on Drugs and Crime, World Drug Report 2013.11 Abbreviation: MDMA, 3,4-methylenedioxymethamphetamine.

  3. Acute kidney injury and various forms of nephrotoxicity associated with the use of designer drugs.
    Figure 3: Acute kidney injury and various forms of nephrotoxicity associated with the use of designer drugs.

    Representative examples of the associated pathology are shown beneath the mechanisms of acute kidney injury. Abbreviations: 25I-NBOMe, 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl)phenylethylamine; MDMA, 3,4-methylenedioxymethamphetamine.

  4. Examples of designer drugs.
    Figure 4: Examples of designer drugs.

    a,b | Synthetic cannabinoids often referred to as 'SPICE' or 'K2'. c,d | Synthetic cathinones also known by the street name 'bath salts'. Images reproduced with permission from the Drug Enforcement Agency, US Department of Justice.

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  1. Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT 06520–8029, USA.

    • Randy L. Luciano &
    • Mark A. Perazella

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R.L.L. and M.A.P. researched the data for the article, provided substantial contributions to discussions of its content, wrote the article and undertook review and/or editing of the manuscript before submission.

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The authors declare no competing interests.

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  • Randy L. Luciano

    Dr Randy L. Luciano obtained his PhD in biomedical sciences from New York University, USA in 2002, and an MD from the University of Connecticut, USA in 2008. He subsequently completed an internal medicine residency and nephrology fellowship at Yale University School of Medicine, USA. Dr Luciano is currently a Clinical Instructor in Internal Medicine for the Section of Nephrology at Yale University School of Medicine. His clinical and academic interests include urine sediment analysis, the effects of nonsteroidal anti-inflammatory drugs and herbal medications on kidney function and the treatment of glomerular disease.

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  • Mark A. Perazella

    Mark A. Perazella is a Professor of Medicine in the Section of Nephrology at Yale University School of Medicine, USA. His clinical areas of interest include drug-related kidney disease, HIV-related kidney disease, acute kidney injury and urine microscopy in kidney disease. He is also Director of the Yale Nephrology Fellowship Training Program, Director of the Yale Acute Dialysis Program and Medical Director of the Yale Physician Associate Program.

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