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Thrombotic microangiopathy and acute kidney injury associated with intravenous abuse of an oral extended-release formulation of oxymorphone hydrochloride: kidney biopsy findings and report of 3 cases.
Am J Kidney Dis. 2014 Jun; 63(6):1022-6.AJ

Abstract

There have been recent reports and warnings of a thrombotic thrombocytopenic purpura-like illness associated with intravenous abuse of a prescription narcotic intended for oral use. Oral extended-release oxymorphone hydrochloride (Opana ER) is an opioid agonist that has undergone a tamper-resistant reformulation. However, instances of melting and dissolving tablets with subsequent injection continue to occur. We report 3 cases of hemolytic anemia and acute kidney injury associated with intravenous abuse of this reformulated drug. All 3 patients underwent native kidney biopsy that showed thrombotic microangiopathy characterized by severe arterial and arteriolar mucoid intimal edema with resultant glomerular and tubular ischemia. All 3 patients required hemodialysis and 2 also underwent therapeutic plasma exchange. Early follow-up suggests that kidney outcome is poor, with only partial recovery of function despite aggressive treatment. The specific component or components of this reformulated drug associated with endothelial injury is unknown. Most importantly, a high degree of clinical suspicion is needed when treating patients with a thrombotic thrombocytopenic purpura-like illness of unknown cause.

Authors+Show Affiliations

Nephropath, Little Rock, AR. Electronic address: josephine.ambruzs@nephropath.com.Department of Nephrology, University of Tennessee Medical Center, Knoxville, TN.Idaho Kidney Institute, Idaho Falls, ID.Nephropath, Little Rock, AR; Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24529995

Citation

Ambruzs, Josephine M., et al. "Thrombotic Microangiopathy and Acute Kidney Injury Associated With Intravenous Abuse of an Oral Extended-release Formulation of Oxymorphone Hydrochloride: Kidney Biopsy Findings and Report of 3 Cases." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 6, 2014, pp. 1022-6.
Ambruzs JM, Serrell PB, Rahim N, et al. Thrombotic microangiopathy and acute kidney injury associated with intravenous abuse of an oral extended-release formulation of oxymorphone hydrochloride: kidney biopsy findings and report of 3 cases. Am J Kidney Dis. 2014;63(6):1022-6.
Ambruzs, J. M., Serrell, P. B., Rahim, N., & Larsen, C. P. (2014). Thrombotic microangiopathy and acute kidney injury associated with intravenous abuse of an oral extended-release formulation of oxymorphone hydrochloride: kidney biopsy findings and report of 3 cases. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(6), 1022-6. https://doi.org/10.1053/j.ajkd.2014.01.015
Ambruzs JM, et al. Thrombotic Microangiopathy and Acute Kidney Injury Associated With Intravenous Abuse of an Oral Extended-release Formulation of Oxymorphone Hydrochloride: Kidney Biopsy Findings and Report of 3 Cases. Am J Kidney Dis. 2014;63(6):1022-6. PubMed PMID: 24529995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thrombotic microangiopathy and acute kidney injury associated with intravenous abuse of an oral extended-release formulation of oxymorphone hydrochloride: kidney biopsy findings and report of 3 cases. AU - Ambruzs,Josephine M, AU - Serrell,Paul B, AU - Rahim,Naeem, AU - Larsen,Christopher P, Y1 - 2014/02/14/ PY - 2013/08/30/received PY - 2014/01/01/accepted PY - 2014/2/18/entrez PY - 2014/2/18/pubmed PY - 2014/7/16/medline KW - Acute kidney injury KW - kidney biopsy KW - kidney pathology KW - oxymorphone KW - thrombotic microangiopathy SP - 1022 EP - 6 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 63 IS - 6 N2 - There have been recent reports and warnings of a thrombotic thrombocytopenic purpura-like illness associated with intravenous abuse of a prescription narcotic intended for oral use. Oral extended-release oxymorphone hydrochloride (Opana ER) is an opioid agonist that has undergone a tamper-resistant reformulation. However, instances of melting and dissolving tablets with subsequent injection continue to occur. We report 3 cases of hemolytic anemia and acute kidney injury associated with intravenous abuse of this reformulated drug. All 3 patients underwent native kidney biopsy that showed thrombotic microangiopathy characterized by severe arterial and arteriolar mucoid intimal edema with resultant glomerular and tubular ischemia. All 3 patients required hemodialysis and 2 also underwent therapeutic plasma exchange. Early follow-up suggests that kidney outcome is poor, with only partial recovery of function despite aggressive treatment. The specific component or components of this reformulated drug associated with endothelial injury is unknown. Most importantly, a high degree of clinical suspicion is needed when treating patients with a thrombotic thrombocytopenic purpura-like illness of unknown cause. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24529995/Thrombotic_microangiopathy_and_acute_kidney_injury_associated_with_intravenous_abuse_of_an_oral_extended_release_formulation_of_oxymorphone_hydrochloride:_kidney_biopsy_findings_and_report_of_3_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)00090-0 DB - PRIME DP - Unbound Medicine ER -