title: Characteristics of AA amyloidosis patients in San Francisco.
abstract: BACKGROUND
  AA amyloidosis due to subcutaneous injection of drugs of abuse has been described in the USA, but all the existing literature is from more than 20 years ago. There is more recent literature from Europe. We have observed a high incidence of AA amyloidosis in the county hospital in San Francisco.
  
  
  METHODS
  Here, we describe 24 patients who had kidney biopsy-proven AA amyloidosis from our hospital from 1998 to 2013. All the patients were thought to have AA amyloidosis from skin popping of illicit drugs after having exhausted the intravenous route. These patients with biopsy-proven AA amyloidosis were analysed further.
  
  
  RESULTS
  All patients were found to have hepatitis C infection, hypertension was not common, most had advanced kidney failure, and acidosis was common as was tubulointerstitial involvement on the kidney biopsy. Other organ involvement included hepatomegaly and splenomegaly in a number of patients; direct myocardial involvement was not seen, but pulmonary hypertension, history of deep vein thrombosis and pulmonary embolism were common. The prognosis of these patients was poor. The mortality rate approached 50% 1 year after biopsy, and most of the patient needed dialysis shortly after diagnosis. Cessation of drug use seemed beneficial but rarely achievable.
  
  
  CONCLUSIONS
  AA amyloidosis from skin popping is common in San Francisco. Most patients with renal involvement end up on dialysis, and mortality rates are exceedingly high.
authors.affiliation: Division of Nephrology, San Francisco General Hospital, University of California, San Francisco, California, USA.
authors.forename: Hiba
authors.initials: H
authors.lastname: Lejmi
authors.affiliation: Division of Pathology, University of California, San Francisco, California, USA.
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Jen
authors.affiliation: Division of Pathology, University of California, San Francisco, California, USA.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Olson
authors.affiliation: Division of Nephrology, San Francisco General Hospital, University of California, San Francisco, California, USA.
authors.forename: Sam H
authors.initials: SH
authors.lastname: James
authors.affiliation: Division of Nephrology, San Francisco General Hospital, University of California, San Francisco, California, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Sam
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000032:analysis*; D001706:Biopsy; D002641:Chicago / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006766:Hospitals, County; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000276:immunology* / Q000473:pathology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D000685:Serum Amyloid A Protein / Q000032:analysis*; D012883:Skin Ulcer / Q000453:epidemiology* / Q000401:mortality; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000685:Serum Amyloid A Protein
keywords: AA amyloidosis; secondary amyloidosis; skin popping