Effect of Drugs on the Kidneys: How Do Drugs Damage the Kidneys?

Chronic drug and alcohol misuse can lead to severe kidney damage or failure. The damage is not always direct; some substances may indirectly cause harm to the kidneys via biologic events triggered outside of the renal system itself. These secondary nephrotoxic effects are often a result of muscle breakdown and extremely high body temperatures.¹

The Function of the Kidneys

The kidneys’ job is to filter the blood pumped throughout the body in order to create urine.³ Urine is comprised of excess fluid and waste products and, once formed in the kidneys, it travels to the bladder, where it is stored in anticipation of its periodic excretion.³ Working in concert with each other, these two organs help to stabilize electrolytes and prevent waste and fluid buildup in the blood.³

Drugs and alcohol are no exception when it comes to the renal filtration process. In fact, the majority of misused substances are excreted through the kidneys.²

Kidney functioning can be negatively impacted by:⁴

• Exposure to toxins.
• Aging.
• Hypertension.
• Diabetes.
• Persistent kidney infections.
• Nephrolithiasis (kidney stones).

In some cases, if the kidneys are not functioning properly, the effects of a drug may be amplified. As a result, the kidneys are more easily prone to toxicity from certain drugs and other substances.⁵ This can be particularly dangerous for someone suffering from an addiction to drugs or alcohol who is often increasing their dose to counteract tolerance.

What Drugs Affect the Kidneys?

Many different drugs, both legal and illegal, affect the kidneys’ ability to operate properly. Among these substances are:

• Heroin.
• Cocaine.
• MDMA (ecstasy).
• Inhalants.
• Alcohol.
• Tobacco.
• Painkillers.

Heroin

Heroin, which is an illicit opioid that can be injected, snorted, or smoked, can cause renal damage in a few different ways:

• Coma due to heroin overdose can lead to rhabdomyolysis,² a condition characterized by the breakdown of muscle tissue and release of proteins into the blood.⁶ One of these proteins is myoglobin, which can cause obstruction and kidney damage. Dehydration, acidosis, low blood pressure, and oxygen deficiency can exacerbate these effects.² This syndrome is sometimes seen in users who have not overdosed or experienced a coma.
• Intravenous heroin users are more likely to contract bacterial and fungal infections, which can lead to acute kidney inflammation.²
• Heroin users who inject under the skin have an increased risk of secondary amyloidosis,² or protein build-up in organs and tissues arising in association with the chronic infections and inflammation commonly seen in this population.⁷ This condition can progress to kidney failure if heroin abuse continues.²

Cocaine

Cocaine, a powerful stimulant drug that causes euphoria and increased energy, has been shown to cause kidney complications in acute and chronic users. Much like heroin, rhabdomyolysis is commonly seen in those who abuse cocaine, and it can lead to kidney failure.² As many as 33% of patients in the emergency room with cocaine-related complaints develop acute kidney failure.²

Furthermore, cocaine abuse can lead to renal infarction, as well as promote atherosclerosis, or plaque buildup in the renal arterial walls—conditions that are both characterized by disruptions in the blood flow to the kidneys and resultant tissue damage.² Symptoms of a renal infarction include nausea, vomiting, and severe abdominal pain.⁸

MDMA

Using MDMA, a popular “club drug,” can harm the kidneys in the following ways:

• Hyperthermia, or a dangerous rise in body temperature, caused by dehydration, physical activity, and hot environments can lead to rhabdomyolysis—the breakdown of muscle tissue.^2,9
• Acute renal failure or injury may be caused by malignant hypertension, or severely high blood pressure, which can result from or be exacerbated by MDMA use.^2,10

Inhalants

Inhalants, which are often household items such as cleaning fluids, markers, glues, and spray paint, can lead to kidney lesions.²

A common culprit behind inhalant-mediated renal damage is the toxic chemical toluene, which is present in many glues and other volatile solvents.²

Renal tubular acidosis, a condition in which acid builds up in the blood, is thought to be caused by inhaling products containing toluene.² This disease can progress to chronic kidney disease and kidney failure.¹²

Alcohol

Binge drinking or drinking excess amounts of alcohol over time can harm the kidneys directly. However, even mild alcohol consumption can aggravate existing liver conditions to harm the kidneys indirectly.¹³ Drinking alcohol can significantly alter kidney structure and function.

Experiments with alcohol-administered rats have revealed kidney swelling, impaired renal functioning, and enlarged kidney cells containing a considerable increase in water, fat, and protein.¹³

Further renal complications caused by direct alcohol consumption include:¹³

• Electrolyte disturbances (i.e. sodium, potassium, chloride ions).
• Fluid imbalance.
• Hyponatremia, or abnormally low sodium levels.
• Potassium, magnesium, and calcium depletion.
• Extremely high or low phosphate levels.
• Fluid accumulation.
• Alcoholic ketoacidosis, a condition characterized by dangerously high blood acidity.
• Alkalosis, or low blood acidity.

Tobacco

Smoking tobacco is associated with a number of kidney complications, such as:²

• Sped-up progression of kidney disease in people with high blood pressure and diabetes.
• Microalbuminuria (increase in albumin levels in urine, which can be an ominous predictive marker of future cardiovascular disease).¹⁴

Smoking may also cause progression of the following:

• Renal artery stenosis: narrowing of renal arteries.¹⁵
• Renal lupus: kidney inflammation resulting from lupus.¹⁶
• Renal tubular dysfunction: disruption of fluid and electrolyte homeostasis.¹⁷
• Pulmonary hemorrhage in anti-glomerular basement membrane (anti-gbm) disease: bleeding of the lung in those with anti-gbm disease, an autoimmune disorder that can cause kidney inflammation.¹⁸

In addition to tobacco, the nicotine contained in cigarettes is toxic to the kidneys.¹⁹ It increases the smoker’s blood pressure, which can in turn lead to, or accelerate kidney damage. Nicotine can also exacerbate kidney disease and increase the risk of kidney failure caused by type 1 diabetes, microalbuminuria, and proteinuria.¹⁹

Effects of Painkillers on the Kidneys

Some opioid painkillers—such as Vicodin and Percocet—contain acetaminophen, commonly marketed as Tylenol.

Long-term use of acetaminophen-containing prescription painkillers or acetaminophen alone can cause two types of kidney damage:²⁰

• Analgesic nephropathy: a condition that progresses to irreversible renal failure.²¹
• Chronic kidney failure.

In the case of analgesic nephropathy, a person will likely require a kidney transplant or dialysis to return to normal renal functioning.²¹

The Risks of Injecting Drugs

Injecting drugs increases an individual’s risk of contracting HIV, a virus that compromises the immune system. HIV-associated nephropathy (HIVAN) is a kidney disease often seen in intravenous drug users afflicted with HIV.²

In some cases, this condition can progress to end-stage kidney failure. The prevalence of HIVAN ranges from 3.5% to 12%, depending on the study, and it typically occurs in the advanced stages of HIV.¹¹

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