title: Renal AA-amyloidosis in intravenous drug users--a role for HIV-infection?
abstract: BACKGROUND
  Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades.
  
  
  METHODS
  Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany.
  
  
  RESULTS
  Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1-2 years.
  
  
  CONCLUSIONS
  AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU.
authors.affiliation: Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Jung
authors.forename: Hans Stefan
authors.initials: HS
authors.lastname: Haack
authors.forename: Maike
authors.initials: M
authors.lastname: Buettner
authors.forename: Christoph
authors.initials: C
authors.lastname: Betz
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.forename: Peter
authors.initials: P
authors.lastname: Gruetzmacher
authors.forename: Kerstin
authors.initials: K
authors.lastname: Amann
authors.forename: Markus
authors.initials: M
authors.lastname: Bickel
mesh_terms: D000328:Adult; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000685:Serum Amyloid A Protein