Renal manifestations

The close correlation between disease activity of SLE and level of anti-dsDNA has been documented repeatedly (D4, L24). Anti-dsDNA also represents a reliable marker for acute exacerbation of disease activity (S37, T3). Some report that high-avidity anti-dsDNA correlates with renal manifestations and active lupus nephritis (S37), whereas low-affinity antibodies are associated with cerebral complications (S21, S22). 

The illicit use of drugs involves millions of people worldwide and is associated with a variety of medical complications. In recent years the abuse of both heroin and cocaine have produced major medical problems across the globe. Other illicit agents such as barbiturates, ethyl alcohol, amphetamines, and phencyclidine, as well as drug combinations produce medical complications as well, sometimes with renal manifestations (Table 1). An estimate of 5-6 % of new patients beginning treatment for end stage renal disease in the United States appear to have opiate-related kidney disease [1]. 

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. 

Botanical names Mistaken for Toxins Renal manifestations Ref. 

Glomerulonephritis is one of the most serious complications of systemic lupus erythematosus (SLE) and accounts for much of the morbidity and mortality of patients afflicted with the disease. The renal manifestations of lupus nephritis are variable and encompass a wide spectrum of histopathologic lesions. ° ° The underlying histopathology is associated with different prognoses and responses to therapy, which cannot be predicted solely based on clinical manifestations. A renal biopsy is therefore required to assess the severity of the disease and to predict the short-term and long-term outcomes associated with therapy. Drugs, such as hydralazine and procainamide, are known to precipitate a lupus syndrome however, they are unlikely to cause disease that affects the kidney. 

Renal The most important renal manifestations of hypercalcemia are nephrolithiasis renal tubular dysfunction, particularly decreased concentrating ability and acute and chronic renal insufficiency. 

Musculoskeletal symptoms are the most common clinical manifestations, whereas renal manifestations and CNS involvement are rare. Other common features of DIL include fever, fatigue, pericarditis, pleurisy, and weight loss. Although the classic malar rash is... 

Glomerulonephritis (pauci-immune) occurs in 70% to 85% of patients at some point in the course of the disease (1,3,5,8,10). Extrarenal manifestations usually precede the renal manifestations, often by several months (1). Renal insufficiency... 

Baker SB, Robinson DR. Unusual renal manifestations of Wegener s granulomatosis. Report of two cases. Am J Med 1978 64(5) 883-889. 

Kidney disease is observed in 16% to 49% of CSS patients, usually presenting as rapidly progressive glomerulonephritis with necrosis, crescents, or both (2,3,37,38). Interstitial eosinophil and neutrophil infiltration with edema is also possible. Although mostly associated with anti-MPO Ab (2,3), it is a pauci-immune glomerulonephritis. Other renal manifestations include proteinuria, hypertension, renal insufficiency, and/or renal infarction with or without microaneurysms (1,4,16,22-24,36,38). 

Henoch-Schoenlein purpura (HSP) is a systemic vasculitis affecting the skin, joints, gut, and kidneys. Nephritis in HSP (HSPN) and IgAN seem to be related diseases. Both have mesangial deposition of IgA as the dominating feature in renal biopsy specimens and thus can be discussed in combination. Clinical presentation is typical renal manifestation is present in up to 80% of patients mostly with isolated haematuria. Presentation with acute nephritic syndrome and renal failure or with nephrotic syndrome is rare, but indicates a progressive course of the disease. 

---