Resolution of nephrotic syndrome and lack of progression of heroin-associated renal amyloidosis.
The case of a patient with nephrotic syndrome and renal insufficiency due to renal amyloidosis secondary to chronic subcutaneous heroin abuse who discontinued her drug habit is reported. During the 6 years following the initial renal biopsy, the patient's nephrotic syndrome remitted: urinary protein decreased from 6.8 g/d to 170 mg/d, serum albumin increased from 2.5 g/dL to 3.9 g/dL, and she was no longer edematous. Serum creatinine remained stable at 1.8 mg/dL and creatinine clearance was also unchanged at 34 mL/min. Repeat renal biopsy showed AA amyloidosis involving the glomeruli, with minimal interstitial inflammation. This appears to be the first case of clinical improvement in heroin-associated renal amyloidosis after cessation of drug injections. As in other cases of AA amyloidosis that have improved, the clinical picture does not correlate with the findings on renal biopsy.
Crowley
S
S
Department of Medicine, Albert Einstein College of Medicine, Bronx, N.Y. 10461.
Feinfeld
D A
DA
Janis
R
R
D000686:Amyloidosis / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000150:complications* / Q000534:rehabilitation; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology*; D013997:Time Factors