Nephropathy in illicit drug abusers: a postmortem analysis
Büttner M, Toennes SW, Buettner S, Bickel M, Allwinn R, Geiger H, Bratzke H, Amann KU, Jung O (2014)
Publication Type: Journal article
Publication year: 2014
Journal
Book Volume: 63
Pages Range: 945-53
Journal Issue: 6
DOI: 10.1053/j.ajkd.2014.01.428
Abstract
Illicit drug abuse is an independent risk factor for chronic kidney disease, but the pathogenic consequences of long-term exposure to illicit drugs and contaminants under unsterile conditions remains unclear.Case series.All deceased persons (n 5 129) who underwent forensic autopsy because of suspected connection with illicit drug abuse between January 1, 2009, and April 30, 2011, in Frankfurt/Main, Germany.Clinical characteristics and patterns of drug abuse.Histopathologic alterations of the kidney.Hematoxylin and eosin, periodic acid-Schiff, Sirius, and Congo Red stainings and immunoglobulin A immunohistochemistry of all cases; additional histochemical stainings or immunohistochemistry and electron microscopy in selected cases.Individuals were mostly white (99.2%), were male (82.2%), and had intravenous drug use (IVDU) (81.4%). Median age at death was 39 years and duration of drug abuse was 17 years. The majority (79.1%) took various drugs in parallel as assessed by toxicologic analysis. Despite a young age, the deceased had a high burden of comorbid conditions, especially cardiovascular disease, liver cirrhosis, and infections. Evaluation of the kidneys demonstrated a broad spectrum of pathologic alterations predominated by arteriosclerotic and ischemic damage, mild interstitial inflammation, calcification of renal parenchyma, and interstitial fibrosis and tubular atrophy, with hypertensive-ischemic nephropathy as the most common cause of nephropathy. Interstitial inflammation (OR, 16.59; 95% CI, 3.91-70.39) and renal calcification (OR, 2.43; 95% CI, 1.03- 5.75) were associated with severe IVDU, whereas hypertensive and ischemic damage were associated with cocaine abuse (OR, 6.00; 95% CI, 1.27-28.44). Neither specific glomerular damage indicative for heroin and hepatitis C virus-related disease nor signs of analgesic nephropathy were found.White population, lack of a comparable control group, incomplete clinical data, and absence of routine immunohistochemistry and electron microscopy.Illicit drug abuse is associated with a broad but unspecific spectrum of pathologic alterations of the kidneys. Cocaine abuse has a deleterious role in this setting by promoting hypertensive and ischemic damage.
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APA:
Büttner, M., Toennes, S.W., Buettner, S., Bickel, M., Allwinn, R., Geiger, H.,... Jung, O. (2014). Nephropathy in illicit drug abusers: a postmortem analysis. American Journal of Kidney Diseases, 63(6), 945-53. https://doi.org/10.1053/j.ajkd.2014.01.428
MLA:
Büttner, Maike, et al. "Nephropathy in illicit drug abusers: a postmortem analysis." American Journal of Kidney Diseases 63.6 (2014): 945-53.
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