Chronic drug and alcohol abuse 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 majority of abused substances are excreted through 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 abused substances are excreted through the kidneys 2.
Factors Affecting the Kidneys’ Ability to Remove Drugs
There are a few factors that influence the kidneys’ ability to expel drugs, such as 4:
- The acidity of urine.
- The kidneys’ condition.
- Circulation through kidneys.
- Urine flow.
Kidney functioning can be negatively impacted by 4:
- Exposure to toxins.
- Persistent kidney infections.
- Nephrolithiasis (kidney stones).
In some cases, if the kidneys are not functioning properly, the effects of a drug may be amplified and thus, the kidneys are more easily prone to toxicity from the substance 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, which is an illicit opioid that can be injected, snorted, or smoked, can cause renal damage in a few different ways:
- Coma due to 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, 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.
Further, 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 blood flow to the kidney, and resultant tissue damage 2. Symptoms of a renal infarction include nausea, vomiting, and severe abdominal pain 8.
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, 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.
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.
The Effect of Liver Disease
Individuals with liver disease are at increased risk of experiencing adverse effects on the kidneys. It is common for those with cirrhosis to also have enlarged kidneys, with an estimated 33% increase in kidney weight 13. Some of the other kidney problems resulting from liver disease include
Some of the other kidney problems resulting from liver disease include 13:
- Acute kidney failure.
- Compromised sodium handling.
- Weakened fluid handling.
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 acidity.
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.
It 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.
The Effect of Painkillers
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 by 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 advanced stages of HIV 11.
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- National Institute on Drug Abuse. (2012, December). Kidney Damage.
- Crowe, A. (2000, March 01). Substance abuse and the kidney. Qjm, 93(3), 147-152. doi:10.1093/qjmed/93.3.147
- National Institute of Diabetes and Digestive and Kidney Diseases. (2014, May). The Kidneys and How They Work.
- Le, J. (2016). Drug Elimination.
- Doogue, M. P., & Polasek, T. M. (2011). Drug Dosing in Renal Disease. The Clinical Biochemist Reviews, 32(2), 69-73.
- MedlinePlus Medical Encyclopedia. (2015). Rhabdomyolysis.
- MedlinePlus Medical Encyclopedia. (2015). Secondary systemic amyloidosis.
- Bemanian, S., Motallebi, M., & Nosrati, S. M. (2005). Cocaine-induced renal infarction: Report of a case and review of the literature. BMC Nephrology, 6(10). doi:10.1186/1471-2369-6-10
- National Institute on Drug Abuse. (2006). What are the effects of MDMA?
- Campbell, G. A., & Rosner, M. H. (2008). The Agony of Ecstasy: MDMA (3,4-Methylenedioxymethamphetamine) and the Kidney. Clinical Journal of the American Society of Nephrology, 3(6), 1852-1860. doi:10.2215/cjn.02080508
- Roling, J., Schmid, H., Fischereder, M., Draenert, R., & Goebel, F. D. (2006). HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy–Induced Nephropathy. Clinical Infectious Diseases, 42(10), 1488-1495. doi:10.1086/503566
- National Institute of Diabetes and Digestive and Kidney Diseases. (2010). Renal Tubular Acidosis.
- Epstein, M. (1997). Alcohol Health & Research World, 21(1), 84-93. Alcohol’s Impact on Kidney Function.
- Zeeuw, D. D. (2006). Microalbuminuria as an Early Marker for Cardiovascular Disease. Journal of the American Society of Nephrology, 17(8), 2100-2105. doi:10.1681/asn.2006050517
- National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Renal Artery Stenosis.
- National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Lupus Nephritis.
- Bagga, A., Bajpai, A., & Menon, S. (2005). Approach to renal tubular disorders. Indian J Pediatr The Indian Journal of Pediatrics, 72(9), 771-776. doi:10.1007/bf02734150
- Lahmer, T., & Heemann, U. (2012). Anti-glomerular basement membrane antibody disease: A rare autoimmune disorder affecting the kidney and the lung. Autoimmunity Reviews, 12(2), 169-173. doi:10.1016/j.autrev.2012.04.002
- Cooper, R. (2006). Effect of tobacco smoking on renal function. The Indian Journal of Medical Research, 124(3), 261-268.
- Fored, C. M., & Ejerblad, E. (2001). Acetaminophen, Aspirin, and Chronic Renal Failure. The New England Journal of Medicine, 345, 1801-1808. doi:10.1056/NEJMoa010323
- National Institute of Diabetes and Digestive and Kidney Diseases. (2010). Analgesic Nephropathy (Painkillers and the Kidneys).