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J Nephropathol. 2013;2(3): 196-200.
doi: 10.12860/JNP.2013.31
PMID: 24475449
PMCID: PMC3891138
Scopus ID: 84924987373
  Abstract View: 2421
  PDF Download: 734

Case Report

Serum amyloid A  renal amyloidosis in a chronic subcutaneous (“skin popping”) heroin user

Chad Cooper 1, Jorge E. Bilbao 2, Sarmad Said 1, Haider Alkhateeb 1, Jorge Bizet 1, Ahmed Elfar 1, Olinamyr Davalos 3, Ana T. Meza 3, German T. Hernandez 1 *
*Corresponding author:German T. Hernandez, Texas Tech University Health Sciences Center,4800 Alberta Avenue El Paso, Texas, 79905, USA. Tel: +01 915 545 6619, Fax: +01 915 545 6634, german.hernandez@ttuhsc.edu

Abstract

Background: Systemic AA amyloidosis is a long-term complication of several chronic inflammatory disorders. Organ damage results from the extracellular deposition of proteolytic fragments of the acute-phase reactant serum amyloid A (SAA) as amyloid fibrils. Drug users that inject drug by a subcutaneous route (“skin popping”) have a higher chance of developing secondary amyloidosis. The kidneys, liver, and spleen are the main target organs of AA amyloid deposits. More than 90% of patients with renal amyloidosis will present with proteinuria, nephrotic syndrome, or renal dysfunction.

Case presentation: A 37 year-old female presented to the hospital with a one-week history of pain and redness in her right axilla. Her relevant medical history included multiple skin abscesses secondary to “skin popping”, heroin abuse for 18 years, and hepatitis C. The physical examination revealed “skin popping” lesions, bilateral costovertebral angle tenderness, and bilateral knee swelling. The laboratory workup was significant for renal insufficiency with a serum creatinine of 5 mg/dL and 14.8 grams of urine protein per 1 gram of urine creatinine. The renal biopsy findings were consistent with a diagnosis of renal amyloidosis due to serum amyloid A deposition and acute tubulointerstitial nephritis.

Conclusions: AA renal amyloidosis among heroin addicts seems to be associated with chronic suppurative skin infection secondary to “skin popping”. It is postulated that the chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes is an important factor in the pathogenesis of amyloidosis in these patients. Therefore, AA renal amyloidosis should always be considered in chronic heroin users presenting with proteinuria and renal impairment.

Keywords: Renal amyloidosis, Acute tubulointerstitial nephritis, Heroin, Skin popping

Implication for health policy/practice/research/medical education:

Systemic AA amyloidosis is a long-term complication of several chronic inflammatory disorders. Organ damage results from the extracellular deposition of proteolytic fragments of the acute-phase reactant serum amyloid A (SAA) as amyloid fibrils. AA renal amyloidosis should always be considered in chronic heroin users presenting with proteinuria and renal impairment.  

Please cite this paper as:Cooper C, Bilbao JE, Said S, Alkhateeb H, Bizet J, Elfar A, Davalos O, Meza AT, Hernandez GT. Serum amyloid A renal amyloidosis in a chronic subcutaneous (“skin popping”) heroin user .J Nephropathology. 2013; 2(3): 196-200, DOI: 10.12860/JNP.2013.31

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Revision: 20 Dec 2012
ePublished: 01 Jul 2013
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