Heroin Use Is Associated with AA-Type Kidney Amyloidosis in the Pacific Northwest

Abstract

Background and objectives AA-type kidney amyloidosis is classically associated with chronic autoimmune or inflammatory disorders. However, some urban centers have reported a high prevalence of injection drug use among patients with kidney AA amyloidosis. Previous reports lack control groups to quantify associations and most predate the opioid epidemic in the United States.Design, setting, participants, & measurements We conducted a case-control study of 38 patients with biopsyconfirmed kidney AA amyloidosis and 72 matched control individuals without this condition from two large hospital systems in Seattle, Washington. We ascertained the pattern and duration of heroin use by medical chart review and determined associations using logistic regression.Results Among case patients, 95% had a prior history of heroin use, 87% had skin abscesses, and 76% and 27% had evidence of muscling and skin popping, respectively. After adjustment for age, race, sex, site, and year of biopsy, any heroin use (past or current) was associated with an estimated 170-times higher risk of kidney AA amyloidosis compared with no heroin use (95% confidence interval, 28 to 1018 times higher; P,0.001). Chronic autoimmune disorders were uncommon among case patients in this study. The median time to ESKD among patients with AA amyloidosis was 2.4 years (interquartile range, 0.5-7.5 years).Conclusions Injection heroin use is strongly associated with kidney AA amyloidosis in the Pacific Northwest. Unique aspects of heroin use, in particular geographic regions or frequent associated soft-tissue infections, may be an important cause of this progressive kidney disease.

Secondary amyloidosis associated with heroin use and recurrent infections – A case report

“…Chronic autoimmune disorders were uncommon among case patients in this study. Among the case group, 6 patients had a past history of tuberculosis, 4 were HIV positive, 2 had systemic lupus, 1 had rheumatoid arthritis, 1 had inflammatory bowel disease and 1 had a serum monoclonal protein confirmed by serum and urine immunofixation [ 8 ]. Retrospective studies from Norway and Germany noted heroin use in 50–70% of the patients diagnosed with heroin use in various study periods during the past 15 years [ 9 , 10 ].…”

“…Suppurative infections are common among injection drug users where there is of widespread availability of black tar heroin, which contains impurities that promote venous sclerosis and use of secondary muscle and skin injection sites. The majority of patients in the case control study from Seattle had documentation of muscling or skin-popping, and most had evidence of skin abscesses as noted in the current patient, though generalizability of the findings could be limited by the low and varying incidence of AA amyloidosis noted within different geographic locations [ 8 ].…”

The Changing Spectrum of Heroin-Associated Kidney Disease

“…Finally, amyloidosis with glomerular involvement has been described in heroin users, and it is the subject of a large series by Sharma et al (4) in this issue of the Clinical Journal of the American Society of Nephrology.…”

“…In a large series of 38 patient of AA amyloidosis in the work by Sharma et al (4), 95% of the patients had a history of heroin use, and heroin use imparted an estimated 170-fold higher risk for AA amyloidosis compared with in patients with no heroin use. The authors suggest that the type of heroin used-"the black tar heroin"may explain the high incidence of AA amyloidosis in the Pacific Northwest.…”

Systemic AA Amyloidosis Associated With Intravenous Injection of Oral Prescription Opioids—An Autopsy Case Report

“…8 AA amyloidosis has also been linked to subcutaneous and intravenous injection of illegal drugs, such as heroin and cocaine. [9][10][11][12][13][14][15][16][17][18] Herein, we present the autopsy findings of a woman with chronic pain, chronic kidney disease from biopsy-proven renal AA amyloidosis, heart failure with reduced ejection fraction and hypothyroidism, who developed sepsis and died. She was found to have excipient lung disease and systemic amyloidosis on autopsy.…”