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

Josephine M. Ambruzs, Paul Serrell, Naeem Rahim, Christopher P. Larsen

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1022-1026
Number of pages5
JournalAmerican Journal of Kidney Diseases
Volume63
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Oxymorphone
Thrombotic Microangiopathies
Acute Kidney Injury
Thrombotic Thrombocytopenic Purpura
Kidney
Biopsy
Intravenous Substance Abuse
Tunica Intima
Plasma Exchange
Hemolytic Anemia
Narcotics
Recovery of Function
Opioid Analgesics
Freezing
Tablets
Prescriptions
Renal Dialysis
Edema
Ischemia
Injections

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

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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.",
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