Sixteen patients in six states have been hospitalized with acute kidney injury (AKI) after using synthetic cannabinoids (SCs), according to the Centers for Disease Control and Prevention.

Details of these AKI cases appear in the CDC’s Morbidity and Mortality Weekly Report (2013;62:93-98). The cases include 15 male patients aged 15-33 years and one 15-year old girl. All but one presented with nausea and vomiting, and 12 had abdominal, flank, and/or back pain. None had previous kidney problems or used medications that have been linked to renal dysfunction.

The patients’ peak serum creatinine concentrations range from 3.3 to 21.0 mg/dL , and the apex occurred between one and six days after symptom onset, according to a report prepared by Michael D. Schwartz, MD, of the CDC’s Office Environmental Health Emergencies, and others. Furthermore, eight of the patients had proteinuria, five had casts in the urine, nine had pyuria, and eight had hematuria. Twelve patients underwent renal ultrasonography, which revealed a non-specific increase in renal cortical echogenicity in nine. Eight underwent renal biopsy and six had acute tubular injury, while three had acute interstitial nephritis. Most had full recovery of kidney function within three days of the creatinine peak. Five required hemodialysis, but none died.

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No single SC product explained all 16 cases. A synthetic marijuana product known as XLR-11 was identified in four of the five product samples associated with the cases, and in four of six patients’ clinical specimens. XLR-11 had not been previously reported as being present in SC products.

“We have to continue improving our educational efforts to help everyone—including medical and legal professionals and local community members—recognize the dangers of SCs,” Dr. Schwartz told Renal & Urology News. “As more people become aware of SCs, the more likely it is that we can detect and study all the adverse events related to use of these products.”