Vaping-Induced Acute Tubular Necrosis

Introduction: E-cigarettes have gained popularity as a smoking cessation tool and perceived as a safer alternative to traditional cigarettes. These devices contain harmful compounds such as nicotine, heavy metals, and carcinogens. Recognizing their potential to cause direct lung injury and kidney damage is crucial for nephrologists and clinicians. This case report highlights AKI in a patient using e-cigarettes daily. Case Description: A 60-year-old male with history of Hypertension presented with one-week of headache, and shortness of breath. His BP medications included amlodipine, Hydrochlorothiazide, and losartan. On exam, he was hypertensive with a BP of 240/130, appeared volume overloaded, and was progressively hypoxic. An echocardiogram revealed normal cardiac function. Initial lab tests showed a BUN of 39 mg/dl and creatinine of 2.29 mg/dl, normal electrolytes; LFTs; and CK. Complement levels, ANCA, anti-GBM titers, and infectious serologies were negative. Urinalysis showed no WBCs, eosinophils, granular casts, RBCs, protein, or crystals. Utox was negative, and a renal US showed normal kidneys with no hydronephrosis. Despite adequate diuresis, his oxygenation worsened. He reported increased daily use of e-cigarettes. Steroids were started, and his hypoxia quickly improved. A bronchoscopy with bronchoalveolar lavage (BAL) suggested Diffuse Alevolar Hemorrhage. Despite holding diuretics, his renal function continued to decline, leading to oliguria and necessitating urgent dialysis. A kidney biopsy revealed Acute Tubular Necrosis with 20% tubular atrophy, no immune component, and no microthrombi. While his uremic symptoms improved, he remains dialysis-dependent to this day. Discussion: This case highlights severe acute kidney injury associated with vaping. Proposed mechanisms include oxidative stress and direct toxic cellular injury. Compounds in e-cigarettes, such as nicotine, propylene glycol, glycerol, and flavorings like diacetyl, have been implicated in cellular damage and inflammation. Healthcare providers should be aware of the risks associated with e-cigarettes, including potential kidney injury.