EWODO Hilaire
Internal Medecine, Yaoundé I
October, 2014


Introduction: Chronic kidney disease is a major public health problem which leads to end stage renal disease and cardiovascular mortality. It is estimated that 5 to 10% of adults are affected. Prevention which includes identifying and managing risk factors is an important aspect of management. Several studies in Cameroon have evaluated the prevalence of renal disease in risk group such as diabetes, HTA, chronic viral infection. However, none has looked into possible nephrotoxic agents.Tramadol which is an opioïd derivative increasingly being used as a recreational substance since 2003 throughout the world at large, particularly the Northern region of Cameroon and especially by motorcycle riders. Opioïd in particular have been identified as risk factors for renal disease. The goal of this study is therefore to evaluate the prevalence of renal disease and describe the profile of others risks factors in chronic abuse of tramadol.
Materials and method: We carried out a cross-sectional study in a group of chronic abuses of tramadol and a matched control group (age and sex) consisting solely of nursing students in the town of Garoua from September 2013 to April 2014. We did a convenient sample that was excluded all participants with a known cause of nephropathy.After history and physical examination, random blood and urine samples were collected for each participant and, blood glucose, serum creatinine were analyzed in “Centre Pasteur du Cameroun annexe de Garoua” through kinetic method of Jaffé. Urine dipstick was performed in order to find out proteinuria, leucocyturia and hematuria.The means, standard variations and percentages of variables were expressed, association between variables were analyzed by Chi-square test or Ficher‘s exact test.
Results: 145 tramadol consumers and 64 in the control group who were eligible were included. Tramadol abusers had mean age of 27 ±5, 87 years with 99. 31% males and 39.3% were motorbike riders. The control group was comparable in age and sex and had a higher education level. The mean dose of tramadol per day was 801, 52 ± 624. 79 mg and average duration of consumption was 53.27 ± 41.69 months. Others drugs used included diazepam (29%), Bromazépam (14.5%), NSAIDs (9%), paracetamol (7.6%), codeine (2.1%), cannabis (16.55%), soucourdaï, a local manufactured drug made of formalin(38.62%), mixture of dichloromethane and toluene (8.6% . Among tramadol abusers, the mean blood pressure was 104.85/61.83 mmHg with 23.4% of hypotension and 1.4% of hypertension. However, mean of random blood glucose was 1.07g/l with 5.5% of hypoglycemia and 3.2% of hyperglycemia. The prevalence of kidney disease was 29, 7% and 12, 5 %( p=0.005) in tramadol abusers and control respectively. Proteinuria (10, 2%), leucocyturia (19%), hematuria (1, 5%) and renal failure were the mean renal abnormalities found.
Conclusion : renal disease is prevalent in abusers of tramadol with Signs of glomerular and tubulointerstitial damage. Abusers of tramadol constitute a high risk group for renal disease. Multiple toxic agents consumed by this population may contribute to this high risk.