Autopsy Study Looks at Kidney Damage in Drug Abusers

Illicit drug abuse is associated with a “broad but unspecific” range of pathologic changes in the kidneys, according to a postmortem analysis in the American Journal of Kidney Diseases.

The researchers analyzed the renal findings at forensic autopsy in 129 individuals who died of causes related to illicit drug abuse in one German city between 2009 and 2011. The mean age was 39 years, and 82 percent of the decedents were male. Eighty percent were intravenous drug users. The average known duration of drug use was 17 years. Toxicologic analyses showed a broad spectrum of substances, most commonly opioids, cocaine, and alcohol.

Comorbid conditions included cardiovascular disease, cirrhosis, and infections. Pathologic findings in the kidneys included arteriosclerotic and ischemic damage, mild interstitial inflammation, parenchymal calcification, and interstitial fibrosis and tubular atrophy. The most common cause of nephropathy was hypertensive-ischemic.

Pathologic findings associated with severe intravenous drug use included interstitial fibrosis, odds ratio (OR) 16.59; and renal calcification, OR 2.43. By contrast, cocaine abuse was associated with hypertensive and ischemic damage, OR 6.00. There was no evidence of specific glomerular damage associated with heroin-related or hepatitis C virus–related disease, or of analgesic nephropathy.

Abuse of illicit drugs is a known risk factor for chronic kidney disease, but few studies have examined the renal consequences of long-term drug abuse. This autopsy study shows a broad but nonspecific range of nephropathy in a group of young individuals who died of causes related to drug abuse.

Drug abusers may sustain chronic progressive kidney damage related to “multiple pharmacologic challenges” over time, the researchers write. Cocaine abuse may promote kidney disease progression by inducing hypertensive and ischemic damage [Buettner M, et al. Nephropathy in illicit drug abusers: a postmortem analysis. Am J Kidney Dis 2014; 63:945–953].