Nephropathy in illicit drug abusers: a postmortem analysis.
BACKGROUND
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.


METHODS
Case series.


METHODS
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.


METHODS
Clinical characteristics and patterns of drug abuse.


RESULTS
Histopathologic alterations of the kidney.


METHODS
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.


RESULTS
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.


CONCLUSIONS
White population, lack of a comparable control group, incomplete clinical data, and absence of routine immunohistochemistry and electron microscopy.


CONCLUSIONS
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.
Maike
M
Buettner
Stefan W
SW
Toennes
Stefan
S
Buettner
Markus
M
Bickel
Regina
R
Allwinn
Helmut
H
Geiger
Hansjuergen
H
Bratzke
Kerstin
K
Amann
Oliver
O
Jung
D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000473:pathology