Neugarten J, Gallo G R, Buxbaum J, Katz L A, Rubenstein J, Baldwin D S
Am J Med. 1986 Oct;81(4):635-40. doi: 10.1016/0002-9343(86)90550-4.
Systemic amyloidosis has recently emerged as a major cause of nephropathy among heroin abusers in New York City. Although focal glomerulosclerosis is typically seen in intravenous drug abusers who present with the nephrotic syndrome, those who escape this complication are at risk for the later development of amyloidosis related to their use of the subcutaneous route. Twenty such addicts identified between 1981 and 1984 are described. Patients typically present with chronic suppurative skin infections, edema, the nephrotic syndrome, benign urinary sediment, and normal-sized or enlarged kidneys. Tubular dysfunction, particularly renal tubular acidosis and diabetes insipidus, is frequent. Progression of renal insufficiency is characteristically rapid. Prolonged survival of heroin abusers and exhaustion of intravenous access requiring recourse to the subcutaneous route underlie the occurrence of amyloidosis in the addict population. Chronic suppurative skin infection consequent to repeated subcutaneous injection appears to be the underlying cause.
系统性淀粉样变性最近已成为纽约市海洛因滥用者肾病的主要病因。虽然局灶性肾小球硬化症通常见于出现肾病综合征的静脉注射吸毒者，但那些未出现这种并发症的人有因采用皮下注射途径而在后期发生淀粉样变性的风险。本文描述了1981年至1984年间确诊的20例此类成瘾者。患者通常表现为慢性化脓性皮肤感染、水肿、肾病综合征、良性尿沉渣以及肾脏大小正常或增大。肾小管功能障碍，尤其是肾小管酸中毒和尿崩症很常见。肾功能不全的进展通常很快。海洛因滥用者的长期存活以及静脉通路耗尽而需要采用皮下注射途径是成瘾人群中发生淀粉样变性的基础。反复皮下注射导致的慢性化脓性皮肤感染似乎是根本原因。
