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Injection heroin use associated with kidney amyloid A-type amyloidosis in Pacific Northwest
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Kidney amyloid A-type amyloidosis was strongly associated with injection heroin use in the Pacific Northwest, according to research appearing in the Clinical Journal of the American Society of Nephrology.
Additionally, Arjun Sharma, MD, and colleagues said that unique aspects of heroin use such as geographic regions or frequent associated soft-tissue infections may cause kidney amyloid A (AA)-type amyloidosis.
“AA-type kidney amyloidosis is classically associated with chronic autoimmune or inflammatory disorders,” the researchers wrote. “However, some urban centers have reported a high prevalence of injection drug use among patients with kidney AA amyloidosis.“ Researchers added that previous reports predate the opioid epidemic in the United States and lack control groups to quantify associations.
After adjusting for age, race, sex, site and year of biopsy, researchers found any use of heroin was associated with an estimated 170-times higher risk of kidney AA amyloidosis. The median time to ESKD was 2.4 years for patients with the disease.
In their case-control study of 38 patients with biopsy confirmed kidney AA amyloidosis and 72 matched control individuals without the condition from two hospital systems in Seattle, investigators found 95% had a prior history of heroin use and 87% had skin abscesses. Additionally, researchers found 76% and 27% had evidence of muscling and skin popping, respectively.
“The most plausible mechanism linking injection heroin use with AA amyloidosis in this population is the development of recurrent soft-tissue infections,” the researchers wrote. “Such infections are common among injection drug users in the Pacific Northwest because of widespread availability of black tar heroin, which contains impurities that promote venous sclerosis and use of secondary muscle and skin injection.” – by Jake Scott
Disclosure s : The authors report no relevant financial disclosures.
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