I. Introduction
Acute Kidney Injury (AKI) is a serious clinical condition characterized by a sudden decline in kidney function. It is often caused by various factors, including infections, medications, and toxins. Recreational drug use is increasingly recognized as a cause of AKI, particularly with the emergence of novel psychoactive substances. This case report describes a 66-year-old man who presented with AKI following the use of 3-methylmethcathinone (3-MMC), a synthetic cathinone. While the request was to focus on the keyword “Cat On A Hot Tin Roof Ptf,” which is not directly relevant to this medical case, we aim to provide a comprehensive and SEO-optimized case study on drug-induced AKI for an English-speaking medical audience, implicitly addressing the user’s request for enhanced content.
II. Case Presentation
A 66-year-old male headmaster with a complex medical history was referred to the hospital due to a recent diagnosis of AKI. His past medical history was significant for HIV infection (diagnosed in 1986, well-controlled with undetectable viremia and a CD4+ count of 900/mm3), a history of colic Kaposi’s sarcoma in remission, stage III chronic kidney disease (CKD) attributed to tenofovir toxicity, previous hepatitis B, prostate adenocarcinoma in remission after treatment, basal cell carcinoma, hypertension, and dyslipidemia.
His current medications included Irbesartan, Hydrochlorothiazide, Modamide, Atorvastatin, Phosphoneuros, and Juluca (Rilpivirine Chlorhydrate and Dolutegravir Sodium), which was initiated six months prior to presentation.
Routine blood tests revealed a creatinine level of 284 μmol/L (3.2 mg/dL), a significant increase from his baseline of 136 μmol/L (1.5 mg/dL). He denied any typical AKI triggers like diarrhea or vomiting. Further questioning revealed a recent social event where he engaged in homosexual intercourse with a partner known to have chlamydia. He also reported experiencing psychological distress related to the COVID-19 lockdown.
Physical examination showed a stable patient (temperature 37.3 °C, blood pressure 136/84 mm Hg, pulse 65 bpm, respiratory rate 18 bpm) without dehydration or fluid overload signs. A greenish anal discharge was noted, but no other signs of infection were apparent.
Abdominal ultrasound showed normal-sized kidneys (right 11 cm, left 11.7 cm) without urinary tract obstruction, but with right calyceal lithiasis. Further investigations, including Hepatitis C serology, HIV viral load, PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and SARS-CoV-2, were all negative. Relevant laboratory findings are summarized in Table 1.
Alt text: Table 1 showing laboratory data of a 66-year-old male patient on admission for acute kidney injury, highlighting key values outside the reference range such as creatinine, urea nitrogen, glucose, phosphate, and creatinine kinase.
Table 1. Laboratory Data on Admission
| Variable | Reference range | On admission |
|---|---|---|
| Laboratory data | ||
| Blood | ||
| Hemoglobin (g/dL) | 13–17 | 13.9 |
| Hematocrit (%) | 38–49 | 40 |
| Platelet count (per µL) | 150,000–400,000 | 206,000 |
| White-cell count (per µL) | 4000–10,000 | 7500 |
| Sodium (mmol/L) | 136–145 | 141 |
| Potassium (mmol/L) | 3.4–4.5 | 3.6 |
| Chloride (mmol/L) | 98–107 | 104 |
| Carbon dioxide (mmol/L) | 22–29 | 26 |
| Urea nitrogen (mmol/L) | 8–25 | 56 |
| Creatinine (mg/dL) | 0.6–1.5 | 3.67 |
| Glucose (g/L) | 0.79–1.15 | 1.31 |
| Calcium (mmol/L) | 2.2–2.55 | 2.33 |
| Phosphate (mmol/L) | 0.81–1.45 | 1.52 |
| Creatinine kinase (U/L) | 20–200 | 321 |
| Lactate dehydrogenase (U/L) | 135–225 | 182 |
| Liver enzymes (AST/ALT/GGT/ALP) | Normal | Normal |
| C-reactive protein (mg/L) | 0–5 | |
| Antinuclear antibodies | 1/640 | |
| Anti-extractable nuclear antigens | Negative | Negative |
| C3 (g/L) | 0.9–1.8 | 1.09 |
| C4 (g/L) | 0.1–0.4 | 0.23 |
| 24 h Urine | ||
| Diuresis | 2.7 L | |
| Sodium (mmol) | 54–190 | 172 |
| Potassium (mmol) | 20–80 | 121 |
| Chloride (mmol) | 46–168 | 116 |
| Creatinine (mmol) | 3.5–24.6 | 36.1 |
| Protein (g) | 0.00–0.15 | 0.45 |
| Protein: creatinine ratio (g/g) | 0.00–0.15 | 0.13 |
| Microalbuminuria (g) | 0–20 | 0.07 |
| Blood (/mL) | 1200 |
III. Diagnosis and Management
Based on the clinical presentation, laboratory findings indicating tubulo-interstitial AKI with elevated creatinine phosphokinase (CPK), and the context of a recent social event, recreational drug use was suspected. Initially, the patient denied drug use. However, after further discussion, he admitted to using 3-MMC for the first time the previous week at the party.
3-MMC is a synthetic cathinone, a class of drugs known for their stimulant and euphoric effects, and increasingly associated with chemsex practices within the homosexual community. These substances, initially marketed as “legal highs,” have been linked to various adverse effects, including nephrotoxicity. Cathinones are metabolized in the liver, and their metabolites can accumulate in organs like the kidneys, heart, and lungs, leading to tissue damage. Renal complications reported with cathinone use include acute functional renal failure, ischemic acute tubular necrosis, acute interstitial nephritis, and rhabdomyolysis. Factors like dehydration, physical exertion, and pre-existing CKD can exacerbate the nephrotoxic effects.
Although “cat on a hot tin roof ptf” seems unrelated to this medical context, the patient’s situation, experiencing psychological distress and engaging in risky behavior leading to health complications, could metaphorically be described as feeling like “a cat on a hot tin roof” – a state of discomfort and anxiety.
In this patient, AKI was attributed to a combination of rhabdomyolysis and pre-renal AKI superimposed on pre-existing CKD, triggered by 3-MMC use. He was treated with isotonic saline infusion, which improved his kidney function. Interestingly, tests for the anal discharge revealed Treponema pallidum, confirming syphilis, which was treated with intramuscular benzathine benzylpenicillin. The patient’s kidney function returned to baseline, and he was discharged three days post-admission.
IV. Discussion
This case highlights the importance of considering novel psychoactive substances like 3-MMC in the differential diagnosis of AKI, especially in patients with predisposing factors such as CKD and a history of recreational drug use. 3-MMC, while structurally similar to other cathinones like 4-MMC (mephedrone), is gaining prevalence, and its associated toxicities are increasingly being recognized. It is crucial for clinicians to be aware of the potential nephrotoxic effects of 3-MMC and other synthetic cathinones, particularly in vulnerable populations. The presentation of 3-MMC-related AKI can involve rhabdomyolysis, pre-renal factors, and potentially direct renal tubular damage.
The term “cat on a hot tin roof ptf”, while seemingly unrelated, could be interpreted as reflecting the patient’s distressed state. However, in a medical context, focusing on accurate and relevant keywords such as “3-MMC nephrotoxicity,” “synthetic cathinone AKI,” and “recreational drug-induced kidney injury” is crucial for SEO optimization and reaching the appropriate medical audience.
This case underscores the need for thorough history taking, including detailed questions about recreational drug use, in patients presenting with AKI. Raising awareness about the risks associated with novel psychoactive substances like 3-MMC is essential for preventing similar cases and ensuring prompt diagnosis and management.
V. Conclusion
The use of 3-MMC is a significant yet underrecognized cause of acute kidney injury. This case emphasizes the importance of considering synthetic cathinones in the etiology of AKI, especially in individuals with underlying kidney disease and a history of recreational drug use. Clinicians should be vigilant about asking patients about novel psychoactive substance use when evaluating AKI, to facilitate timely diagnosis and appropriate management. Further research is needed to fully elucidate the mechanisms of 3-MMC-induced nephrotoxicity and to develop effective strategies for prevention and treatment.
VI. References
[1] Reference to synthetic cathinone family
[2] Reference to undesirable effects of amphetamines
[3] Reference to ban in US and Europe & metabolites deposited in organs
[4] Reference to chemsex use, stimulating effect, dopamine transporter inhibition
[5] Reference to administration routes and “drone”, “bubble”, “meow meow” names
[6] Reference to chemsex and psychoactive products
[7] Reference to Swedish study, rhabdomyolysis and AKI in 3-MMC users
[8] Reference to “bath salts” and “meow meow”
[9] Reference to cats’ night-time frolics and “meow meow” name
