Biopsy-proven Crescentic Glomerulonephritis Following Inhaled Methamphetamine Use: An Exceptional Case of Confirmed Drug-induced Glomerular Injury

Methamphetamine, a potent addictive illicit stimulant, is known to cause nephrotoxicity through multiple mechanisms involving the drug and its metabolites. However, glomerulonephritis associated with methamphetamine use is rare. Previous case reports have described crescentic glomerulonephritis typically in association with infection-related glomerulonephritis. A confirmed case of severe crescentic glomerulonephritis directly attributed to methamphetamine use has not been previously reported. We report the first confirmed case of severe crescentic glomerulonephritis directly linked to prolonged inhalation of methamphetamine in the absence of other identifiable causes. A 35-year-old Thai male with transfusion-dependent β-thalassemia and prior splenectomy, who developed severe acute kidney injury after chronic methamphetamine use by smoking crushed tablets rolled into cigarettes. Urine toxicology was positive for amphetamines. Kidney biopsy revealed extensive crescentic glomerulonephritis without evidence of immune-complex deposition. Despite cessation of methamphetamine and supportive treatment, the patient progressed to end-stage kidney disease requiring maintenance hemodialysis. This case highlights a potential causal relationship between chronic methamphetamine use and crescentic glomerulonephritis. It expands the current understanding of methamphetamine-induced kidney injury and suggests direct vascular or endothelial toxicity as a potential mechanism. This rare complication should be considered in methamphetamine users presenting with acute kidney injury.