Heroin nephropathy

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... 

This chapter will review the various renal manifestations of illicit drug abuse. It will focus on the clinical and pathologic presentation, the course, the treatment, and the pathogenesis of these lesions. Secondary renal infectious complications will not be discussed, except for the interrelationship of HIV and heroin nephropathy. 

The most frequent lesion described has been focal segmental glomerulosclerosis (FSGS) progressing to global sclerosis. This lesion has been classically referred to as "heroin nephropathy" and is the lesion seen in Black heroin addicts in the USA. Ninety percent of all... 

Addicts typically use street heroin mixed with a number of adulterants, such as quinine or lactose, and they often inject combinations of illicit drugs. Three patients who developed the clinical and morphologic picture of heroin nephropathy claimed to have used only intravenous pentazocine and tripelennamine [41]. It has been suggested that the contaminants rather than the narcotic itself might be the inciting factor through the mechanism of mesangial overload [34]. 

Figure 1, Renal biopsy of patient with heroin nephropathy showing focal glomerulosclerosis plus severe tubulointerstitial damage.

One study demonstrated that the mean time to end stage renal disease for heroin addicts with an initial glomerular filtration rate (GFR) greater than 60cc/ min was 43 months compared to 3.6 months for patients with HIV nephropathy who had a similar GFR [59]. By stratifying the patients with heroin nephropathy, those with a GFR from 20-60 cc/min took a mean of 20 months to reach uremia, while those with an initial clearance less than 20 cc/ min progressed to uremia in a mean of 7 months [59]. Isolated reports have suggested... 

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... 

Cunningham EE, Brentjens JR, ZIeleznyMA, Andres GA,VenutoRC. Heroin nephropathy-a clinicopathologicand epidemiologic study. Am J Med 1980 68 47-53. 

Moody C, Kaufman R, McGuire D, Grossman S.The role of adulterants in heroin nephropathy. NKF (New Orleans) 1985 32. Brown SM, Stimmel B, Taub RN, Kochwa S, Rosenfield RE. Immunologic dysfunction in heroin addicts. Arch Intern Med 1974 134 1001-1006. 

KunisC, Olesnicky M, Nurse H. Heroin nephropathy-clinical pathologic correlations. Proc9th Int Congr Nephrol 1984 102A. Cunningham EE, Zielezny MA, Venuto RC. Heroin-associated nephropathy - a nationwide problem. JAMA 1983 250 2935-2936. 

The pathologic lesions of heroin nephropathy can be either focal or diffuse with sclerosis involving glomeruli segmentaUy or globally. This variability may relate to the stage of the disease at biopsy since some patients present with preserved renal function and oth-... 

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