Bilateral renal cortical necrosis associated with smoking synthetic cannabinoids

Figure 2 Proposed mechanism of synthetic cannabinoids-induced thrombotic microangiopathy. Prolonged hypotension secondary to the inhibitory effect of the SCBs on the sympathetic tone and vascular smooth muscle cells along with endothelial release of nitric oxide can lead to stasis followed by endothelial ischemia and microthrombosis leading to renal cortical necrosis. SCBs: Synthetic cannabinoids; SNS: Sympathetic nervous system; VSM: Vascular smooth muscle.