Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis
Usage of novel non-tobacco oral nicotine delivery products (ONDPs) has been increasing among adolescents in the United States. It is presumed that they are less toxic than their tobacco-containing counterparts, but that has not been examined in controlled studies. Most of the studies have focused on...
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MDPI AG
2024-11-01
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| author | Ratna Acharya William Clapp Kiran Upadhyay |
| author_facet | Ratna Acharya William Clapp Kiran Upadhyay |
| author_sort | Ratna Acharya |
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| description | Usage of novel non-tobacco oral nicotine delivery products (ONDPs) has been increasing among adolescents in the United States. It is presumed that they are less toxic than their tobacco-containing counterparts, but that has not been examined in controlled studies. Most of the studies have focused on non-renal manifestations of tobacco consumption via different means. The renal manifestations of non-tobacco ONDPs are not very well known, especially in immunocompromised patients. A 19-year-old male transplant recipient presented with flank pain and a few days’ history of intake of ZYN<sup>R</sup> pouches. Immunosuppression was with tacrolimus, mycophenolate, and steroids. Baseline serum creatinine was 1.1–1.3 mg/dL. Laboratory evaluation showed elevated C-reactive protein, increased serum creatinine and blood urea nitrogen, leukocytosis, neutrophilia, and increased lactate dehydrogenase (LDH). Infectious disease work-up was negative. A kidney transplant biopsy showed severe acute tubular injury/necrosis (ATN) without evidence of rejection. Donor-specific antibodies were negative. Other etiologies of hemolysis were negative. He did not require renal replacement therapy. Kidney function and LDH improved gradually. The most recent follow-up eight months after presentation showed a serum creatinine level of 2.6 mg/dL with stable electrolytes, with eGFR of 35 mL/min/1.73 m<sup>2</sup>. Here, we describe a 19-year-old adolescent with a kidney transplant who sustained ATN leading to advanced chronic disease apparently following the usage of non-tobacco ONDP. Further larger studies are needed to study ATN as a possible renal manifestation of these next-generation products to raise awareness among the public. |
| format | Article |
| id | doaj-art-ec8e0a71abaa47dbaad274a10896254e |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-ec8e0a71abaa47dbaad274a10896254e2024-11-26T18:12:39ZengMDPI AGMedicina1010-660X1648-91442024-11-016011184610.3390/medicina60111846Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular NecrosisRatna Acharya0William Clapp1Kiran Upadhyay2Department of Pediatrics, Nemours Children’s Hospital, Orlando, FL 32827, USADivision of Anatomic Pathology, Department of Pathology, University of Florida, Gainesville, FL 32610, USADivision of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, FL 32610, USAUsage of novel non-tobacco oral nicotine delivery products (ONDPs) has been increasing among adolescents in the United States. It is presumed that they are less toxic than their tobacco-containing counterparts, but that has not been examined in controlled studies. Most of the studies have focused on non-renal manifestations of tobacco consumption via different means. The renal manifestations of non-tobacco ONDPs are not very well known, especially in immunocompromised patients. A 19-year-old male transplant recipient presented with flank pain and a few days’ history of intake of ZYN<sup>R</sup> pouches. Immunosuppression was with tacrolimus, mycophenolate, and steroids. Baseline serum creatinine was 1.1–1.3 mg/dL. Laboratory evaluation showed elevated C-reactive protein, increased serum creatinine and blood urea nitrogen, leukocytosis, neutrophilia, and increased lactate dehydrogenase (LDH). Infectious disease work-up was negative. A kidney transplant biopsy showed severe acute tubular injury/necrosis (ATN) without evidence of rejection. Donor-specific antibodies were negative. Other etiologies of hemolysis were negative. He did not require renal replacement therapy. Kidney function and LDH improved gradually. The most recent follow-up eight months after presentation showed a serum creatinine level of 2.6 mg/dL with stable electrolytes, with eGFR of 35 mL/min/1.73 m<sup>2</sup>. Here, we describe a 19-year-old adolescent with a kidney transplant who sustained ATN leading to advanced chronic disease apparently following the usage of non-tobacco ONDP. Further larger studies are needed to study ATN as a possible renal manifestation of these next-generation products to raise awareness among the public.https://www.mdpi.com/1648-9144/60/11/1846oral nicotine delivery productacute tubular necrosiskidney transplantadolescents |
| spellingShingle | Ratna Acharya William Clapp Kiran Upadhyay Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis Medicina oral nicotine delivery product acute tubular necrosis kidney transplant adolescents |
| title | Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis |
| title_full | Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis |
| title_fullStr | Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis |
| title_full_unstemmed | Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis |
| title_short | Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis |
| title_sort | association of oral tobacco free nicotine delivery product with acute renal tubular necrosis |
| topic | oral nicotine delivery product acute tubular necrosis kidney transplant adolescents |
| url | https://www.mdpi.com/1648-9144/60/11/1846 |
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