Natural History of Heroin-Associated Nephropathy

Of 14 black heroin addicts with massive proteinuria, 12 manifested a typical syndrome including edema, hypoalbuminemia and hypercholesterolemia. Renal biopsies obtained in 13 patients showed focal and segmental glomerular sclerosis in 11, typically (seven of 11 patients) associated with focal glomerular deposition of IgM and β1C/β1A globulin. Deterioration of renal function was continuous and rapid, so that in all eight patients with follow-up examinations, uremia developed in six to 48 months. Although focal sclerosis may have other as yet unidentified causes (especially in children), its occurrence in 11 of 13 nephrotic heroin addicts biopsied in the absence of other systemic or renal disease indicates a causal relation to heroin abuse. The combination of focal glomerular sclerosis and IgM and β1C/β1A globulin localization in glomeruli is otherwise unusual, having been noted in only two of 400 adult renal biopsies originating from a general nephrology service. An undefined response of the addict to heroin or its vehicle may be responsible for the renal syndrome. (N Engl J Med 290:19–23, 1974)