Overview
Ketamine-associated uropathy (KAU) is a spectrum of urinary tract damage linked to ketamine use. While historically associated with recreational abuse, the risk in therapeutic settings is debated and appears lower 1.Diagnosis
Urological symptoms can range from lower urinary tract symptoms (LUTS) to upper tract disease 1.
Prevalence estimates for LUTS in recreational users range from 44% to 77%, and for upper tract disease from 8% to 30% 1.
More recent studies suggest lower risks, with urological symptoms in therapeutic settings reported in 0% to 24% of patients, and little difference between ketamine and placebo groups in randomized controlled trials 1.
The literature on KAU is critically examined, with reasons for potential false positive findings considered 1.Management
Strategies for risk reduction are discussed for patients requiring long-term ketamine therapy 1.
No specific treatment recommendations are provided in the abstract.Special Populations
No information is available in the abstracts.Key Recommendations
The prevalence of ketamine-associated uropathy in therapeutic contexts is likely lower than suggested by studies of recreational users, with randomized controlled trials showing minimal differences in urological symptoms compared to placebo 1. (Evidence: Moderate)
Risk reduction strategies should be considered for patients requiring long-term ketamine maintenance therapy 1. (Evidence: Expert opinion)
Careful interpretation of uropathy findings is necessary, considering potential reasons for false positive results in the literature 1. (Evidence: Expert opinion)References
1 Andrade C. Ketamine-Associated Uropathy During Therapeutic and Nontherapeutic Use: Prevalence, Clinical Features, Mechanisms, and Strategies for Risk Reduction. The Journal of clinical psychiatry 2025. link