Renal AA-amyloidosis in intravenous drug users--a role for HIV-infection?

BMC Nephrol. 2012 Nov 21;13:151. doi: 10.1186/1471-2369-13-151.

Abstract

Background: Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades.

Methods: Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany.

Results: Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1-2 years.

Conclusions: AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Amyloidosis / complications
  • Amyloidosis / diagnosis
  • Amyloidosis / epidemiology*
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology*
  • Retrospective Studies
  • Serum Amyloid A Protein
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / diagnosis
  • Substance Abuse, Intravenous / epidemiology*

Substances

  • Serum Amyloid A Protein