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, 29 (2), 248-257

The Nephrologist's Guide to Cannabis and Cannabinoids


The Nephrologist's Guide to Cannabis and Cannabinoids

Joshua L Rein. Curr Opin Nephrol Hypertens.


Purpose of review: Cannabis (marijuana, weed, pot, ganja, Mary Jane) is the most commonly used federally illicit drug in the United States. The present review provides an overview of cannabis and cannabinoids with relevance to the practice of nephrology so that clinicians can best take care of patients.

Recent findings: Cannabis may have medicinal benefits for treating symptoms of advanced chronic kidney disease (CKD) and end-stage renal disease including as a pain adjuvant potentially reducing the need for opioids. Cannabis does not seem to affect kidney function in healthy individuals. However, renal function should be closely monitored in those with CKD, the lowest effective dose should be used, and smoking should be avoided. Cannabis use may delay transplant candidate listing or contribute to ineligibility. Cannabidiol (CBD) has recently exploded in popularity. Although generally well tolerated, safe without significant side effects, and effective for a variety of neurological and psychiatric conditions, consumers have easy access to a wide range of unregulated CBD products, some with inaccurate labeling and false health claims. Importantly, CBD may raise tacrolimus levels.

Summary: Patients and healthcare professionals have little guidance or evidence regarding the impact of cannabis use on people with kidney disease. This knowledge gap will remain as long as federal regulations remain prohibitively restrictive towards prospective research.


Cannabis sativa W.O.Müll. (A) flowering male and (B) seed-bearing female plant, actual size; (1) male flower, enlarged detail; (2) and (3) pollen sac of same from various angles; (4) pollen grain of same; (5) female flower with cover petal; (6) female flower, cover petal removed; (7) female fruit cluster, longitudinal section; (8) fruit with cover petal; (9) same without cover petal; (10) same; (11) same in cross-section; (12) same in longitudinal section; (13) seed without hull. From Franz Eugen Köhler's Medizinal-Pflantzen. Published and copyrighted by Gera-Untermhaus, FE Köhler in 1887 (1883–1914). Original figure is now in the public domain.
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