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Nephrotoxic effects of designer drugs: synthetic is not better!

Key Points

  • Designer drugs are synthesized to produce effects similar to scheduled or controlled chemical compounds

  • These drugs are used as 'legal highs' and are undetectable by standard toxicology tests

  • Designer drugs classified as amphetamine derivatives, phenylpiperazine derivatives, synthetic cathinones, synthetic cannabinoids, phencyclidine derivatives and synthetic opioids are increasingly being used as recreational drugs

  • When used excessively and/or when contaminated with toxic substances, designer drugs are associated with adverse renal effects

  • Acute kidney injury and hyponatraemia can result from the use of designer drugs

  • Clinicians should be aware of the toxicological profile of designer drugs and the potential for adverse renal effects


Designer drugs are synthetic, psychoactive substances with similar structures and activity to existing scheduled drugs or controlled chemical compounds. The use of these drugs is not generally considered illegal and they cannot be detected using standard toxicology tests—essentially they are considered to be 'legal highs'. Over the past several years, increasing numbers of designer drugs have become available. These drugs are classified as amphetamine derivatives, phenylpiperazine derivatives, synthetic cathinones, synthetic cannabinoids, phencyclidine derivatives and synthetic opioids. Although euphoria is the desired effect, neuropsychiatric and cardiac manifestations are frequently observed in individuals using these drugs at high doses or using drugs that are contaminated with other substances. Some designer drugs are also associated with adverse renal effects, including acute kidney injury from pigment nephropathy, acute tubular necrosis, obstructive nephropathy and hyponatraemia. The misuse of these drugs should be recognized and clinicians made aware of the potential for acute nephrotoxicity as the health burden of these compounds increases.

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Figure 1: New designer drugs.
Figure 2: Prevalence of illicit drug use among high school students (aged 17–18 years) in the USA.
Figure 3: Acute kidney injury and various forms of nephrotoxicity associated with the use of designer drugs.
Figure 4: Examples of designer drugs.


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R.L.L. and M.A.P. researched the data for the article, provided substantial contributions to discussions of its content, wrote the article and undertook review and/or editing of the manuscript before submission.

Corresponding author

Correspondence to Mark A. Perazella.

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The authors declare no competing financial interests.

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Luciano, R., Perazella, M. Nephrotoxic effects of designer drugs: synthetic is not better!. Nat Rev Nephrol 10, 314–324 (2014).

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