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QJM Advance Access published online on September 6, 2006
QJM, doi:10.1093/qjmed/hcl092
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 23, 2006
Accepted May 26, 2006

Original Papers

Renal amyloidosis in intravenous drug users

J.O. Connolly 1 *, J.D. Gillmore 1, H.J. Lachmann 2, A. Davenport 1, P.N. Hawkins 3, and R.G. Woolfson 1

1 From the Centres of Nephrology, Royal Free and University College Medical School, London, UK
2 From the Centres of Nephrology, Royal Free and University College Medical School, London, UK; From the Centres of Amylodosis and Acute Phase Proteins, Royal Free and University College Medical School, London, UK
3 From the Centres of Amylodosis and Acute Phase Proteins, Royal Free and University College Medical School, London, UK

* To whom correspondence should be addressed.
J.O. Connolly, E-mail: j.connolly{at}medsch.ucl.ac.uk


  Abstract

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.


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