Severe Lower Urinary Tract Symptoms Associated with Bilateral Hydronephrosis and Renal Impairment: A Case Report of Ketamine Abuse Uropathy with a Review of the Literature

Background:Ketamine which is a short acting anaesthetic is also being used in night clubs and dance parties as a recreational drug. Its adverse effect on lower urinary tract, have been recently described by researchers. However, there is limited literature regarding the effects of ketamine on the urinary tract. Aims:To report our experience with ketamine related uropathy of bladder dysfunction, upper urinary tract obstruction and renal failure To review the literature on Ketamine associated uropathy. Case Report:A young man was admitted with a history of diurnal urinary frequency, urgency, nocturia and haematuria. He admitted to regular use of Ketamine for recreational purposes. He had many psychological problems. His initial haematological and serum biochemistry investigations and urine cytology tests were normal. He had cystoscopy under general anaesthesia which revealed an inflamed urinary bladder and histology of his bladder biopsy specimen was consistent with bladder mucosal ulceration and chronic inflammation. He continued to use ketamine for recreational purposes. His urinary symptoms persisted and eventually his renal function deteriorated. Ultrasound scan of kidneys and renal tract as well as an isotope renogram conf i rmed bi latera l hydronephrosis and bilateral ureteric obstruction. He continued using Ketamine. His renal function and his lower urinary tract symptoms continued to worsen further. He had Isotope Renograms and ultrasound scans of the kidneys and urinary tract which confirmed worsening hydronephrosis and bilateral ureteric obstruction. Conclusions:Ketamine has recently been gaining popularity as a party drug among dance drug users in some parts of the world. Due to its short duration of action it is falsely believed that ketamine is not as harmful as some of the other drugs such as heroin or cocaine. There is evidence that Regular and intermittent Ketamine abuse is very harmful and induces uropathy including bladder dysfunction, upper urinary tract obstruction and renal failure. Cessation of Ketamine abuse for one year tends to lead to improvement or resolution of the symptoms related to Ketamine abuse. Persistent and prolonged period of Ketamine abuse may lead to permanent renal damage which would be devastating to the patient. A high index of suspicion is required in order to diagnose Ketamine abuse uropathy. There is the need to educate the public about the harmful effects of Ketamine on the urinary tract which includes renal failure Perhaps mass educational programmes through television, radio, newspaper publications, as well as class room teaching is required in order to disseminate information on the devastating effect Ketamine abuse has on the urinary tract.