Synthetic marijuana or synthetic cannabinoid (SC) use is becoming more problematic in the contemporary society. Sharma Prabhakar, M.D., a nephrologist at Texas Tech Physicians—Internal Medicine, said their harmful effects are not well understood by the public and the medical community, and the incidence of complications related to synthetic cannabinoids is increasing.
“About 5 percent of all drug abusers reporting to emergency room are purely due to SC,” Prabhakar said. “ That doesn’t include mixed drug use.”
Synthetic cannabinoids, or synthetic cannabinoid receptor agonists, were first invented for research purposes. In 2012, synthetic cannabinoids were used in 11.3 percent of high school seniors; 4.4 percent of 8th graders and 8.8 percent of 10th graders also reportedly abused these substances.
“We recently reported and published three cases of synthetic cannabinoid-induced acute kidney injury or AKI,” Prabhakar said. “Information about kidney injury from SC is relatively new information to medical community. The first reports appeared in literature just two years ago. Due to increasing incidence of AKI caused by synthetic cannabinoids, there are ongoing investigations on the pathophysiology of this injury.”
Currently, XLR-11, or its metabolites, are believed may be the culprit causing AKI. Prabhakar said it has become important to obtain a history of illicit drug use in patients who have AKI, especially young adults in whom the condition cannot be explained by other causes, even with negative urine drug screen results.
“Screening tests are not yet available and synthetic cannabinoids are not detected in a urine drug screen,” Prabhakar said. “Public awareness and education could play an important role in prevention of AKI caused by synthetic cannabinoids.”
Other street drugs that are notorious for causing kidney damage include:

• Heroin: Chronic heroin abuse causes typically focal segmental glomerulosclerosis (FSGS), which manifests as severe urinary protein loss, edema, progressive renal failure and hypertension.
• Cocaine: Cocaine has been linked to severe hypertension and renal failure. It is a potent constrictor of arteries and also known to cause heart attacks in young adults.
• Anabolic steroids: These are known to cause heavy proteinuria and renal damage.
• Bath salts: These are substances of abuse, which have nothing to do with bath products that are becoming more common and are difficult to recognize due to negative toxicology screening. Various preparations contain the stimulant designer drugs mephedrone (4-methylmethcathinone) and metheledioxypyrovaleronone (MDPV). Bath salts are synthetic stimulants that cause hallucinations, aggression, severe hyperthermia, hyperkalemia, rhabdomyolysis, shock, DIC and dialysis-dependent AKI with a negative serum and urine drug screen
• Amphetamines and metamphetamine: These are known to cause acute kidney injury as well as hypertension and chronic progressive renal failure.
• Ectasy: Ecstasy has been associated with acute kidney injury that is most commonly secondary to non-traumatic muscle damage (rhabdomyolysis) but also has been reported to cause liver failure and inflammation of blood vessels or vasculitis.