Heroin associated nephropathy--a post-mortem study.

Renal specimens were obtained from 179 autopsies of persons autopsied in the Institute of Forensic Medicine, University of Bonn, from 1987 to 1997. All persons were known as intravenous drug addicts. All renal specimens were examined with hematoxylin-eosin, PAS, Siriusred and Gomori (methenamine silver trichrome stain) and investigated with primary antibody against LCA (leucocyte common antigen), CD 68, IgG and IgM. 105 specimens (61.7%) showed a mono-lymphocytic membranoproliferative glomerulonephritis (MPGN), 48 specimens (45.7%) deposits of IgM. No case with focal segmental glomerulosclerosis (FSGS) as reported in male African-American intravenous drug addicts was found. In 37 out of 54 cases, hepatitis antibodies were detected in serum and three out of these 54 cases were HIV-positive. Chronic hepatitis B and C are known to be associated with glomerulonephritis. We found some cases without detection of hepatitis antibodies but with severe glomerulonephritis. In contrast to African-American drug addicts, European drug addicts do not develop a FSGS but a MPGN, partly due to heroin or other adulterants and apparently independent from hepatitis infection.