From november 2006 to february 2009, 20 patients visited taipei veterans general hospital due to ketaminerelated lower urinary tract symptoms. Obstructive nephropathy, also know as uropathy, refers to the syndrome caused by urinary tract obstruction, either functional or anatomic. A new clinical entity causing lower urinary tract symptoms. Obstructive uropathy is a condition in which urine flow has been partially or completely blocked. Obstructive uropathy symptoms, diagnosis and treatment. Ketamine consumption as a recreational drug is on an increasing trend. Long term ketamine use can cause inflammation and irritation to the urinary bladder and urethra, and. The urinary tract system is comprised of many structures that. Sometimes chronic obstructive uropathy is present at birth. Obstructive uropathy is a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction obstructive nephropathy. Hyperactivity of nmethyldaspartate nmda receptors may be one of the factors in the genesis of neuropathic pain np. Ketamine is also a drug of misuse and to give an indication of current levels of.
Symptoms, less likely in chronic obstruction, may include pain radiating to the t11 to t12 dermatomes and abnormal voiding eg, difficulty voiding, anuria, nocturia, andor polyuria. Chronic obstructive uropathy is a condition characterized by slowly developing obstruction in the urinary tract at the kidneys, ureters, bladder outlet, or urethra, eventually resulting in an obstruction to the flow of urine. In other cases, the condition is the result of an accident, injury, or another illness. Using the standardized tools to assess patients with ketamine abuse, patients. Ketamine is a dissociative anesthetic and analgesic that is the most potent nmda receptor antagonist currently available for human use. Regardless of why or how the disorder develops however, it causes serious, even lifethreatening complications, including kidney damage and renal failure. Intact urothelial barrier function in a mouse model of. Essential tests, which should be performed in all ku patients, are 1 detailed history. Disability benefits and chronic obstructive uropathy. The aim of the present study was to elucidate the mechanism of ketamineinduced fibrosis in association with epithelialtomesenchymal transition emt mediated by transforming growth factor. Obstructive uropathy investigations bmj best practice. Uropathy, the most powerful holistic therapy is an advanced treatise on autotherapeutic remedies including all there is to know about urine therapy this book takes the reader through a path of self discovery that helps each person understand how the body functions and.
Obstructive uropathy is a condition where urine cannot flow outside due to an obstruction along the urinary tract, due to a number of possible causes. Ketamine abuse causes lower urinary tract symptoms, with the underlying pathophysiology poorly understood. In recent years, the abuse of ketamine has dramatically increased worldwide, especially as. When kidney function is affected, this is termed obstructive nephropathy. Meant to be an authoritative guide for psychiatrists and others interested in understanding and applying ketamine psychedelic psychotherapy kpp, this paper focuses on its pharmacology, phenomenology, and clinical applications. Bridging the gap between science and public health. Ketamine uropathy ku describes the effects of ketamine on the urinary system. Iv ketamine therapy faq huraibi rehab institute, pllc. This causes the urine to back up and injure one or both kidneys. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the n.
This report presents our observations and management on urinary tract damage caused by ketamine abuse. Ketamine also has major abuse potential and is used illicitly as a recreational drug. Blockage of urinary flow, which can occur at any level in the urinary tract. An overview of these studies can be found in this book chapter.
Animal models of addiction are used to test the induction of drugtaking behaviour which might be. These patients were subsequently confirmed to be ketamine abusers. Because of the hallucinatory effects of the drug, recreational ketamine abuse has been increasingly reported in recent years. Ketamine is a parenterally administered, general anesthetic used largely for short term diagnostic and surgical procedures, but which has been limited in use because of its psychological side effects including vivid hallucinations, agitation and confusion. A number of underlying conditions can result in obstructive uropathy, most commonly urolithiasis and benign prostatic hyperplasia. Rosemary waigh rated it did not like it may 02, 2019. Ketamine abuse potential and use disorder request pdf. Urine therapy books a listing of literature on uropathy. From 2007 onwards reports of ketamine abuse uropathy have been reported from time to time in the medical literature but most medical practitioners and the public are not aware of the presentation, pathophysiology, investigation and. Chronic ketamine abuse can damage many body organs 1, 2. With growing ketamine abuse, ketamine induced uropathy kiu has become a vital health issue in recent years. Pdf with growing ketamine abuse, ketamineinduced uropathy kiu has become a vital health issue in recent years. The risk of upper urinary tract involvement in patients with. Since 2007, when the earliest reports appeared on bladder dysfunction and cystitis associated with recreational ketamine use,2,3 our understanding of the problem has grown, but.
Vesicoureteral reflux vur, also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into the ureterskidneys. The assistance of a behavioral specialist enhances ones response to medication therapy. Ketamine is a popular choice for young drug abusers. Long term ketamine use can cause inflammation and irritation to the urinary bladder and urethra, and similar changes have recently been described in the biliary tract, resulting in an acute or chronic cholestatic liver injury that can resemble sclerosing cholangitis. Ketamine is a dissociative anesthetic widely used by physicians and veterinarians in the united states.
Emerging evidence has shown that longterm and chronic ketamine use or abuse can lead to damages in the urinary tract, a spectrum of. Obstructive uropathy msd manual professional edition. There is a growing body of literature for three decades suggesting efficacy of subanaesthetic doses of ketamine in the treatment of np. The obstructed kidney should be decompressed as early as possible because of progressive loss of renal function with prolonged obstruction. Ketamine can produce a dissociative state and hallucinations and therefore is not commonly used in adult anesthetic practice. Multiorgan dysfunction related to chronic ketamine abuse. Inflammatory picture and hypersensitive reaction are observed in the histopathology of ketamine.
Ketamine use and abuse pdf ketamine use and abuse pdf free download, ketamine use and abuse pdf, ketamine use and abuse ebook content increasing use of ketamine as a recreational drug in asia, europe, and america is a great burden on society at large, leading to aspirational strain, unemployment, and crime. It includes urinary tract dilatation, impedance and the. Although the lower urinary tract is the primary affected site, involvement of the upper urinary tract is common, and kiu may progress rapidly. Ketamine can produce a state of dependence as shown in various animal models. Urine normally travels in one direction forward, or anterograde from the kidneys to the bladder via the ureters, with a 1way valve at the vesicoureteral ureteralbladder junction preventing backflow. In contrast, the treatment of severe depression is complex and usually requires a higher level of interventions. Ketamineinduced ulcerative cystitis and bladder apoptosis. Acute obstructive uropathy is a condition in which there is a sudden blockage at any site in the urinary tract at the kidneys, ureters, bladder outlet. Contrary to intuitive thinking, the duration of ketamine abuse. The diagnosis of kiu is primarily established by the clinical presentation of severe lower urinary tract symptoms and a history of ketamine abuse, and can be further confirmed by a urine examination and urodynamic studies.
We analyzed the clinical presentations, daily ketamine dose, interval between ketamine usage to develop luts, urodynamic studies, radiological image findings, cystoscopic and ureterorenoscopic. Request pdf ketamine abuse potential and use disorder ketamine is a noncompetitive. The treating urologist then recalled two other male patients both aged 30 years with similar clinical findings who presented around that same period. May affect one or both kidneys, depending on the level of obstruction. Ketamineassociated uropathy can involve the upper urinary tract. With growing ketamine abuse, ketamineinduced uropathy kiu has become a vital health issue in recent years. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and. Chronic abuse of ketamine leads to ketamineassociated uropathy, commonly presenting with lower urinary tract symptoms and suprapubic pain.
It is a misnomer to use ketamine cystitis or ketamine bladder syndrome as, whilst the bladder is often most severely affected, the whole urinary tract may be damaged. The use of ketamine in neuropathic pain springerlink. Renal distal renal tubular acidosis can predict the transplantation is the final option where available development of overt nephropathy after surgery in and when affordable. The recognition of ketamineassociated uropathy as a distinct disease entity was later echoed by reports from taiwan 7, united kingdom 8, malaysia 9 and. To date, at least 110 cases of ketamineinduced uropathy kiu have been reported in the literature. Further advancements are being made as the molecular mechanisms involved in the pathophysiology of the obstructed kidney become known to us.
Upper tract involvement is observed in a portion of patients. 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. Bladder wall fibrosis is a major complication of ketamineinduced cystitis kc, but the underlying pathogenesis is poorly understood. Disruption of urothelial barrier function has been hypothesized to be a major mechanism for ketamine cystitis, yet the direct evidence of impaired urothelial barrier function is still. Severe lower urinary tract symptoms associated with.
Ketamineinduced bladder fibrosis involves epithelialto. Iv ketamine infusion therapy is reserved for patients with treatmentresistant depression with or without suicidal thoughts. Although the lower urinary tract is the primary affected site, involvement of the. Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction obstructive nephropathy. The obstruction of urine flow from the kidney to the bladder may be complete or partial.
Data including demographics, pattern of ketamine abuse, pelvic pain and. The destruction of the lower urinary tract by ketamine abuse. A randomized, doubleblind, placebocontrolled trial. Imaging diagnosis of ketamineinduced uropathy sciencedirect. Request pdf the destruction of the lower urinary tract by ketamine abuse. Doubling of uterus, cervix and vagina with obstruction. An important companion volume to christys landmark book on uropathy, as martha christy explains, in the course of using urine therapy, i found that combining the therapy with homeopathic medicines in particular can produce incredible results, even for the toughest, most stubborn chronic conditions. Obstructive uropathy functional or anatomic obstruction of urinary flow at any level of the urinary tract the point of obstruction can be as proximal as the calyces and as distal as the urethral.
Doubling of uterus w doubling of cervix and vagina w obst. Among 572 patients with ketamine uropathy seen between 2011 and 2015, 17% had. Obstructive uropathy is blockage of urinary flow, which can affect one or both kidneys depending on the level of obstruction. Topical 2% amitriptyline and 1% ketamine in neuropathic pain syndromes. The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Urine backs up into the kidney and causes it to become. Obstructive uropathy occurs when urine cannot drain through the urinary tract. Evaluation of the extent of ketamineinduced uropathy. The interval between the beginning of ketamine abuse and the occurrence of lower urinary tract symptoms luts should be noted. Ketamine abuse can damage the urinary tract and cause lower urinary tract symptoms luts. If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal. Articles in press latest issue article collections all issues. Nephrectomy may be required for a nonfunctioning kidney.
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