NEPHROTIC SYNDROME IN HEROIN ADDICTS

doi:10.1016/S0140-6736(72)90007-4

The Lancet

Volume 299, Issue 7740, 1 January 1972, Pages 17-20

https://doi.org/10.1016/S0140-6736(72)90007-4 Get rights and content

Abstract

Eight heroin addicts with clinical nephrotic syndrome are described. Renal biopsies in seven patients revealed focal membranoproliferative glomerulonephritis and binding of IgM and B1C by electron and immunofluorescence microscopy. No evidence for a known cause of nephrotic syndrome could be identified. While the specific stimulus which resulted in immunoglobulin and complement deposition in the kidneys of these heroin addicts remains obscure, likely possibilities are bacterial or viral contaminants in the injectate, toxins used in diluting the heroin, or the heroin itself.

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Citation Excerpt :
Our study found a strong association of prior, but not current, intravenous drug use with the presence of proteinuria. Glomerular abnormalities were first described in heroin users in the early 1970s, even before the AIDS epidemic.20-22 Heroin-associated nephropathy is a syndrome of massive proteinuria after prolonged heroin use, progressing to end-stage renal disease.23
Proteinuria may be an early marker of chronic kidney disease in human immunodeficiency virus (HIV)-infected patients with coexisting chronic hepatitis and/or drug use. Minorities are at greater risk of chronic kidney disease. Data are limited about risk factors for proteinuria in Hispanic drug users with and without HIV infection.
A cross-sectional study.
A community-recruited Hispanic cohort to study the role of drug use in HIV-associated malnutrition composed of 4 groups (106 HIV-infected drug users, 96 HIV-uninfected drug users, 38 HIV-infected non–drug users, and 47 healthy controls). Patients on renal replacement therapy were excluded.
HIV infection, chronic hepatitis, history of hypertension or diabetes, and intravenous drug use (never, prior, or current).
The presence of proteinuria was defined as urine dipstick result of 1+ or greater. Multivariable logistic regression was used to identify independent risk factors for proteinuria.
Of 287 patients with available data, 24 (8.4%) had proteinuria. In univariate analyses, those with HIV infection; prior, but not current, intravenous drug use; and a history of hypertension or diabetes were more likely to have proteinuria. In multivariate analyses, significant risk factors for proteinuria were HIV infection (odds ratio, 9.2; 95% confidence interval, 1.9 to 45.8; P = 0.007); prior, but not current, intravenous drug use (odds ratio, 4.7; 95% confidence interval, 1.4 to 15.3; P = 0.01); and history of hypertension or diabetes (odds ratio, 8.2; 95% confidence interval, 3.1 to 21.7; P < 0.001).
The cross-sectional study design makes it difficult to establish the temporal relationship. The number of outcomes in relation to the number of predictors is small.
HIV and prior intravenous drug use, but not chronic hepatitis or current intravenous drug use, were independently associated with proteinuria in this Hispanic population. Longitudinal studies to assess the development of proteinuria and chronic kidney disease in this high-risk population are warranted.
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Immune-Mediated and Other Glomerular Diseases
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NEPHROTIC SYNDROME IN HEROIN ADDICTS

Abstract

Am. J. Med.

Clin. Res.

Proc. Soc. exp. Biol. Med.

Immunology

Diagnostic Procedures for Viral and Rickettsial Disease

J. clin. Invest.