Renal amyloidosis in intravenous drug users

QJM. 2006 Nov;99(11):737-42. doi: 10.1093/qjmed/hcl092. Epub 2006 Sep 6.


Background: Intravenous drug abuse is associated with a wide variety of acute and chronic medical complications. The increased longevity of drug users has seen the emergence of new diseases as a result of chronic bacterial and viral infection. We recently observed an increase in the number of cases of renal amyloidosis among intravenous drug users in central London.

Aim: To describe here the demographic and clinical characteristics of such patients.

Methods: Patients were identified retrospectively from computerized patient renal biopsy records at University College London and Royal Free Hospitals from 1990-2005. Clinical information was collected from patient hospital records.

Results: We identified 20 cases of AA amyloidosis; 65% occurred between January 2000 and September 2005. All were proteinuric (mean 7.3 g/l, range 0.5-14.8 g/l) and 13 required dialysis within 1 month of diagnosis. Of the remaining seven, four developed end-stage renal failure after mean follow-up of 16 months (range 6-30). Nine died, with median survival of 19 months (range 1-62); all deaths were due to sepsis.

Discussion: Secondary AA amyloidosis is a serious complication of chronic soft tissue infection in intravenous drug users in central London. Affected individuals invariably presented with nephrotic range proteinuria and advanced renal failure. Treatment options are limited and the outcome for such patients on renal replacement was poor. Cross-disciplinary strategies are needed to prevent this serious complication of long-term intravenous drug abuse.

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology
  • Adult
  • Amyloidosis / epidemiology*
  • Amyloidosis / etiology
  • Female
  • Humans
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / etiology
  • London
  • Male
  • Medical Records Department, Hospital
  • Middle Aged
  • Proteinuria / epidemiology
  • Proteinuria / etiology
  • Retrospective Studies
  • Substance Abuse, Intravenous / complications*
  • Substance-Related Disorders / epidemiology