Renal AA-amyloidosis in intravenous drug users – a role for HIV-infection?

Jung, Ok‐Sang; Haack, Hans Stefan; Buettner, Maike; Betz, Christoph; Stephan, Christoph; Gruetzmacher, Peter; Amann, Kerstin; Bickel, Markus

doi:10.1186/1471-2369-13-151

Cited by 27 publications

(53 citation statements)

References 26 publications

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“…Median times to ESKD and death among patients with AA amyloidosis in this study were only 2.4 and 4.2 years, respectively. These findings, in conjunction with previous case series, suggest that unique aspects of heroin use in particular geographic locations are likely to be an important cause of kidney AA amyloidosis and highlight the rapidly progressive and often fatal course of this disease (10,11).…”

Section: Discussionsupporting

confidence: 73%

“…Although reported outcome data remains sparse, the results of this study suggest a rapidly progressive course of the disease that may inform patient counseling and planning for dialysis, if indicated. Although there are anecdotal reports of disease remission after discontinuation of injection drug use, available data are insufficient to assess the effect of abstinence on the course of the disease (10,20). Strengths of this study include the evaluation of biopsyconfirmed cases of kidney AA amyloidosis and the inclusion of a matched control group to quantify the size of associations with heroin use.…”

Section: Discussionmentioning

confidence: 99%

“…Occasional case reports and case series have reported a high prevalence of injection heroin use among patients with kidney AA amyloidosis (6)(7)(8)(9)(10)(11). These reports originated from large urban centers and described AA amyloidosis in association with longstanding heroin use and frequent suppurative infections.…”

Section: Introductionmentioning

confidence: 99%

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

Sharma¹,

Govindan²,

Toukatly³

et al. 2018

CJASN

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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.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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

Sharma¹,

Govindan²,

Toukatly³

et al. 2018

CJASN

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“…Finally, new cases of amyloidosis have been detected in groups that were not traditionally associated with amyloidosis. Thus, AA amyloidosis was the most frequent cause of kidney disease among intravenous drug users evaluated at two different reference centers in Frankfurt, Germany 25. Amyloidosis accounted for 50% of the cases, which is much more than any other type of kidney disease.…”

Section: Epidemiologymentioning

confidence: 97%

Systemic AA amyloidosis: epidemiology, diagnosis, and management

Asúa¹,

Costa²,

Galván³

et al. 2014

CLEP

205

133

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The term “amyloidosis” encompasses the heterogeneous group of diseases caused by the extracellular deposition of autologous fibrillar proteins. The global incidence of amyloidosis is estimated at five to nine cases per million patient-years. While amyloid light-chain (AL) amyloidosis is more frequent in developed countries, amyloid A (AA) amyloidosis is more common in some European regions and in developing countries. The spectrum of AA amyloidosis has changed in recent decades owing to: an increase in the median age at diagnosis; a percent increase in the frequency of primary AL amyloidosis with respect to the AA type; and a substantial change in the epidemiology of the underlying diseases. Diagnosis of amyloidosis is based on clinical organ involvement and histological evidence of amyloid deposits. Among the many tinctorial characteristics of amyloid deposits, avidity for Congo red and metachromatic birefringence under unidirectional polarized light remain the gold standard. Once the initial diagnosis has been made, the amyloid subtype must be identified and systemic organ involvement evaluated. In this sense, the 123I-labeled serum amyloid P component scintigraphy is a safe and noninvasive technique that has revolutionized the diagnosis and monitoring of treatment in systemic amyloidosis. It can successfully identify anatomical patterns of amyloid deposition throughout the body and enables not only an initial estimation of prognosis, but also the monitoring of the course of the disease and the response to treatment. Given the etiologic diversity of AA amyloidosis, common therapeutic strategies are scarce. All treatment options should be based upon a greater control of the underlying disease, adequate organ support, and treatment of symptoms. Nevertheless, novel therapeutic strategies targeting the formation of amyloid fibrils and amyloid deposition may generate new expectations for patients with AA amyloidosis.

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“…So werden renale AA-Amyloidosen bei HIV-Infizierten vornehmlich im Rahmen von viszeraler Leishmaniose, Morbus Castleman und intravenösem Drogenabusus beschrieben. Allerdings ist unklar, welche Rolle der HI-Virus bei der Genese der Amyloidose spielt [15]. Zudem war in der späten Periode ca.…”

Section: Diskussion ▼unclassified