Vaping-associated acute tubular injury presenting as a pulmonary–renal syndrome in an adolescent

Electronic cigarette use is increasingly common among adolescents and is associated with a widening range of toxic effects, although renal complications remain poorly characterized and are rarely confirmed histologically in this age group. We describe a previously healthy 14-year-old boy who developed oliguria, dark- colored urine, severe hypertension, seizures, and pulmonary infiltrates two days after electronic cigarette use. Serum creatinine rose to 10.6 mg/dL, requiring hemodialysis. The presentation raised concern for a pulmonary–renal syndrome, prompting empiric corticosteroids and plasma exchange. However, serological testing was negative, urinary β2-microglobulin was markedly elevated, and kidney biopsy showed acute tubular injury without glomerular or immune-mediated disease. Immunosuppression was withdrawn, and kidney function recovered completely, remaining normal at 18 months. This case shows that vaping-associated acute tubular injury can mimic a pulmonary–renal syndrome and highlights the value of kidney biopsy in adolescents with unexplained severe acute kidney injury.