Connolly J O, Gillmore J D, Lachmann H J, Davenport A, Hawkins P N, Woolfson R G
Centre for Nephrology, Royal Free Hospital, Pond Street, London, UK.
QJM. 2006 Nov;99(11):737-42. doi: 10.1093/qjmed/hcl092. Epub 2006 Sep 6.
Intravenous drug abuse is associated with a wide variety of acute and chronic medical complications. The increased longevity of drug users has seen the emergence of new diseases as a result of chronic bacterial and viral infection. We recently observed an increase in the number of cases of renal amyloidosis among intravenous drug users in central London.
To describe here the demographic and clinical characteristics of such patients.
Patients were identified retrospectively from computerized patient renal biopsy records at University College London and Royal Free Hospitals from 1990-2005. Clinical information was collected from patient hospital records.
We identified 20 cases of AA amyloidosis; 65% occurred between January 2000 and September 2005. All were proteinuric (mean 7.3 g/l, range 0.5-14.8 g/l) and 13 required dialysis within 1 month of diagnosis. Of the remaining seven, four developed end-stage renal failure after mean follow-up of 16 months (range 6-30). Nine died, with median survival of 19 months (range 1-62); all deaths were due to sepsis.
Secondary AA amyloidosis is a serious complication of chronic soft tissue infection in intravenous drug users in central London. Affected individuals invariably presented with nephrotic range proteinuria and advanced renal failure. Treatment options are limited and the outcome for such patients on renal replacement was poor. Cross-disciplinary strategies are needed to prevent this serious complication of long-term intravenous drug abuse.
静脉注射吸毒与多种急慢性医学并发症相关。吸毒者寿命的延长导致了因慢性细菌和病毒感染而出现的新疾病。我们最近观察到伦敦市中心静脉注射吸毒者中肾淀粉样变性病例数量有所增加。
在此描述此类患者的人口统计学和临床特征。
通过回顾性研究，从伦敦大学学院和皇家自由医院1990年至2005年的计算机化患者肾活检记录中识别患者。临床信息从患者医院记录中收集。
我们识别出20例AA型淀粉样变性病例；65%发生在2000年1月至2005年9月之间。所有患者均有蛋白尿（平均7.3g/l，范围0.5 - 14.8g/l），13例在诊断后1个月内需要透析。其余7例中，4例在平均随访16个月（范围6 - 30个月）后发展为终末期肾衰竭。9例死亡，中位生存期为19个月（范围1 - 62个月）；所有死亡均因败血症。
继发性AA型淀粉样变性是伦敦市中心静脉注射吸毒者慢性软组织感染的严重并发症。受影响个体总是表现为肾病范围蛋白尿和晚期肾衰竭。治疗选择有限，此类接受肾脏替代治疗的患者预后较差。需要跨学科策略来预防长期静脉注射吸毒的这种严重并发症。
