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Abstract: FR-OR094

Renal Polyvinylpyrrolidone Deposition from Illicit Drug Use Is Associated with Tubulointerstitial Nephropathy

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Stalund, Ida Viken, Haukeland University Hospital, Bergen, Norway
  • Grønseth, Heidi, Haukeland University Hospital, Bergen, Norway
  • Reinholt, Finn P., Oslo University Hospital, Rikshospitalet, Oslo, Norway
  • Strom, Erik Heyerdahl, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  • Svarstad, Einar, University of Bergen, Bergen, Norway
  • Marti, Hans-Peter, University of Bergen, Bergen, Norway
  • Leh, Sabine, Haukeland University Hospital, Bergen, Norway
Background

Polyvinylpyrrolidone (PVP) is a water-soluble polymer used as an excipient in drugs for oral use. When injected, high molecular weight PVP can neither be metabolized nor excreted by glomerular filtration and will accumulate in the body, resulting in PVP deposition disease. From 2009 to 2016, we observed 25 kidney biopsies with PVP deposition in Norway. All biopsies were from patients with opioid addiction and chronic kidney disease (CKD). The most likely source of PVP in these patients is illicitly injected, PVP-containing opioid substitution drugs intended for oral use.

Methods

We collected clinical data from the Norwegian Kidney Biopsy Registry and from affiliated medical records. We reviewed the biopsies, assessed light microscopy, immunohistochemistry and electron microscopy, and obtained additional pathological parameters using quantitative methods.

Results

The cohort consisted of 25 adults with a mean age of 37. All were suffering from opioid addiction with a known history of injecting opioids regularly, and 22 of them were prescribed opioid substitution drugs. 22 (88%) of the patients had positive hepatitis C virus serology and none were HIV-positive. All patients had CKD with a mean serum creatinine of 205 mole/L and mean estimated glomerular filtration rate of 35 mL/min/1.73m2 (Range 14-58). The majority (64%) had stage 3b CKD. Four patients had slightly to moderately increased urinary protein:creatinine-ratio.

All biopsies revealed widespread areas of tubular atrophy and interstitial fibrosis with a mean proportion 64% (Range 32-86). The interstitium of these areas contained single and grouped histiocytes with characteristic bluish vacuoles indicating PVP deposits (fig. 1). Apart from one patient with lupus nephritis, the biopsies showed no evidence of other diseases that could explain the widespread atrophy.

Conclusion

Opioid drug addiction is associated with a high burden of morbidity and various renal diseases. This large case series illustrates that PVP deposition might be a rare cause of chronic renal insufficiency in these patients.

Fig. 1: PVP-containing histiocytes in the interstitium. (H&E)

Funding

  • Government Support - Non-U.S.