heroin and Glomerulonephritis

Most glomerulopathies are immunologically-mediated. Their pathogenesis is now better understood. The role of cell-mediated immunity has recently been envisaged. The role of circulating antibodies now seems to be more important than that of circulating immune complexes. Antibodies may recognize structural or "planted" antigens in the kidney, the latter being non-renal molecules that may bind renal structures for non-immune reasons. The linear or granular pattern observed at immunofluorescence depends upon the regular or irregular distribution of the antigen. In susceptible individuals, various toxins (heavy metals such as mercury or gold, drugs with an SH group, non-steroidal anti-inflammatory agents) may induce an immune glomerulopathy. It has recently been shown that Brown-Norway rats exposed to one of the above-mentioned agents develop anti-self class II T lymphocytes that are responsible for a polyclonal activation of B cells. Among the various autoantibodies that are produced, some have a nephritogenic potential. Other drugs are responsible for glomerular lesions due to a direct toxic effect of the compound. Doxorubicin induces a nephrotic syndrome in the rabbit, while mitomycin induces a haemolytic uraemic syndrome in humans. Finally, drug addiction often leads to glomerulosclerosis.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Antibody Formation; Antirheumatic Agents; Autoantibodies; Doxorubicin; Glomerulonephritis; Heroin; Humans; Immunity, Cellular; Lithium; Lymphocyte Activation; Mice; Mitomycins; Organogold Compounds; Organomercury Compounds; Penicillamine; Rabbits; Rats; Rats, Inbred Strains

Topics: Animals; Anti-Glomerular Basement Membrane Disease; Anti-Inflammatory Agents; Antibodies; Captopril; Drug Hypersensitivity; Environmental Exposure; Glomerulonephritis; Gold; Heroin; Humans; Hydrocarbons; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Immune Complex Diseases; Kidney Diseases; Kidney Glomerulus; Lupus Erythematosus, Systemic; Mercury; Nephritis, Interstitial; Penicillamine; Penicillins; Rifampin

Topics: Anemia, Sickle Cell; Cryoglobulinemia; Endothelium; Glomerulonephritis; Hemolytic-Uremic Syndrome; Hepatitis B; Heroin; Humans; Kidney; Kidney Transplantation; Leukemia; Lupus Erythematosus, Systemic; Malaria; Schistosomiasis; Staphylococcal Infections; Vascular Surgical Procedures

Glomerulopathies with fibrillary deposits form a heterogeneous group of renal diseases that can be identified only by means of electron microscopy. A case of a rare type of such a nephropathy, the collagenofibrotic glomerulopathy with focus on differential diagnostics is presented and current knowledge relating to this renal disease is reviewed.

Topics: Adult; Female; Glomerulonephritis; Heroin; Humans; Kidney Glomerulus; Microscopy, Electron

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.

Topics: Adult; Endocarditis, Bacterial; Female; Gentamicins; Glomerulonephritis; Heroin; Humans; Hypertension, Renovascular; Kidney; Kidney Diseases; Kidney Tubular Necrosis, Acute; Male; Rhabdomyolysis; Substance-Related Disorders

Heroin addiction is associated with several severe and occasionally fatal renal complications. Acute renal failure consequent to rhabdomyolysis and myoglobinuria, when treated supportively, carries a good prognosis. Staphylococcal or other bacterial septicemia may in itself prove fatal and is associated with a proliferative immune complex, acute glomerulonephritis, which generally follows the course and prognosis of septicemia. The necrotizing angiitis reported in heroin addicts still is largely undefined. Focal and segmental glomerular sclerosis is the most common pathologic finding in the syndrome of heroin-associated nephropathy (HAN). Typically, HAN presents with massive proteinuria and progresses rapidly to renal failure. Presumptive evidence supports the premise that heroin or its vehicles elicits immunologically mediated renal damage. The antigen still is unidentified. Removing the antigenic challenge by stopping heroin injection apparently interdicts the progression of renal disease. Renal transplantation can be effectively accomplished in patients with HAN without early recurrence if patients discontinue the use of heroin.

Topics: Acute Kidney Injury; Adult; Female; Glomerulonephritis; Heroin; Heroin Dependence; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Myoglobinuria; Polyarteritis Nodosa; Prognosis; Proteinuria; Sepsis; Syndrome; Transplantation, Homologous

Topics: Adult; Antistreptolysin; Blood Protein Electrophoresis; Complement System Proteins; Creatinine; Female; Fluorescent Antibody Technique; Glomerulonephritis; Hepatitis B virus; Heroin; Humans; Immune Sera; Immunoglobulin G; Immunoglobulin M; Kidney; Latex Fixation Tests; Male; Microscopy, Electron; Nephrotic Syndrome; Substance-Related Disorders; Urography