Abuse of illicit drugs is associated with a broad but unspecified spectrum of pathologic alterations of the kidneys, a recent study found.
The study, led by Oliver Jung, MD, of Goethe University, Frankfurt/Main, Germany, included 129 deceased individuals who underwent forensic autopsy because of a suspected connection with illicit drug abuse. Subjects had a median age of 39 years at the time of death, and their median duration of drug abuse was 17 years. Seven individuals (5.4%) had known chronic kidney disease (CKD).
Results showed that arteriosclerotic and ischemic damage, interstitial inflammation, calcifications, and interstitial fibrosis and tubular atrophy were the most frequent pathologies, with hypertensive-ischemic nephropathy the most common cause of nephropathy.
Cocaine abuse was associated with a 6-fold increased risk of hypertensive and ischemic damage, investigators reported online ahead of print in the American Journal of Kidney Diseases. Intravenous drug use was associated with a 16-fold increased risk of interstitial inflammation and a 2.4-fold increased risk of renal calcification. The study revealed no specific glomerular damage indicative of heroin-related and hepatitis C virus-related disease and no signs of analgesic nephropathy.
Opioids and cocaine were the most frequently abused drugs. Most subjects had consumed different types of drugs in parallel. In 102 cases (79.1%), toxicologic findings revealed the presence of 2 or more drugs. Drug intoxication was the most common cause of death according to the final medico-legal report, Dr. Jung and colleagues noted.
“In this postmortem study in an unselected cohort of illicit drug abusers,” the authors wrote, “we found a high burden of kidney pathologic states, although only a few individuals had known CKD. This is analogous to the high frequency of other comorbid conditions, especially cardiovascular diseases, not diagnosed premortem in the individuals in our cohort, emphasizing the notion that many addicts seek medical advice only when acutely ill.”