Amyloidosis heroin abuse

Gallo G, Neugarten J, Buxbaum J, Katz L. Renal amyloidosis in subcutaneous heroin abusers. ASN (New Orleans) 1985 38A. 

Neugarten J, Gallo GR, Buxbaum J, Katz LA, Rubenstein J, Baldwin DS. Amyloidosis in subcutaneous heroin abusers. Am J Med 1986 81 635-640. 

When tested, the amyloid is of the secondary type, amyloid A protein. Serum amyloid A, an acute phase reactant produced by hepatocy tes, circulates complexes to high density lipoprotein and is cleaved into smaller fragments which subsequently polymerize into the P pleated sheet configuration of amyloid [23, 35]. In heroin related amyloidosis, the amyloid is heavily distributed in the tubular basement membranes, vessel walls, and interstitium as well as the glomeruli. There is greater tubular basement membrane and interstitial amyloid deposition in drug related renal amyloid than in secondary renal amyloid unrelated to heroin abuse... 

Heroin nephropathy/clinical course Amyloidosis associated with intravenous drug abuse HIV nephropathy and its relationship to heroin nephropathy Acute kidney injury due to drug-induced rhabdomyolysis Cocaine-induced renal disease 598 599 601 603 605... 

Between 1978 and 1992, almost seventy cases of heroin-related renal amyloidosis were reported [49,50, 57,62-65,69-71]. Most patients were Black males with a mean age almost ten years greater than those patients with the classic heroin nephropathy and a significantly longer course of drug abuse. Since 1992 there have only been isolated case reports of renal amyloidosis in addicts, including one in an HIV+ patient [72], until a... 

Table 2 compares the clinical data in our patients with heroin related amyloidosis (n=24) and heroin related FSGS (n=30) [50]. Most patients with renal amyloidosis had exhausted their intravenous access for drug abuse and resorted to subcutaneous "skinpopping". Almost all patients used heroin, some mixed with cocaine, and two patients reportedly abused only pentazocine and tripelennamine [64]. All patients had chronic dermal ulcerations and suppurative skin infections. 

Amyloid was not found in fhe skin biopsies of several of our patients with heroin related secondary amyloidosis, although interestingly, multiple pulmonary nodules due to AA amyloid have been described in an HIV positive intravenous drug abuser [31a]. 

As with heroin-induced focal segmental glomerulosclerosis, the interstitial cell inflammation is more prominent in the biopsies of patients with substance abuse amyloidosis than in other forms of secondary amyloidosis [22]. Accompanying the tubulointerstitial involvement are a number of physiologic and clinical... 

---