Acute renal failure after amphetamine presenting with loin pain

acute renal failure was probably caused by a combination Case report of renal vasoconstriction, from the amphetamine, and myoglobinurea secondary to exercise. Although his A 25-year-old man was admitted with acute bilateral constant flank pain with no radiation; he had no other symptoms resolved on conservative management, symptoms. The pain began 9 h after taking 0.25 g of amphetamine and running 1.5 miles. He was apyrexial with a pulse rate of 80 b.p.m. and a blood pressure of 124/64 mmHg. The only abnormality on examination was bilateral renal angle tenderness. Urine analysis of his very dark urine was positive for blood and protein, and microscopy revealed hyaline casts. The serum levels of electrolytes and the clotting screen were normal (Table 1). Acute IVP showed no excretion bilaterally by 3.5 h but subsequent films revealed a delayed nephrogram at 18 h (Fig. 1a). He was managed conservatively with analgesia, intravenous fluid replacement and close observation. He continued to pass urine but 24 h later his renal function deteriorated; at 48 h it had improved and the pain settled (Table 1). He was discharged home and IVP performed 6 weeks later showed normal excretion (Fig. 1b) but the patient failed to attend four further appointments to assess his renal function.