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Abstract: PO1507

Black Tar Heroin and AA Amyloidosis

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Kethineni, Rama, University of Utah Health, Salt Lake City, Utah, United States
  • Cho, Monique E., University of Utah Health, Salt Lake City, Utah, United States
  • Revelo Penafiel, Monica Patricia, University of Utah Health, Salt Lake City, Utah, United States
  • Ilkun, Olesya, University of Utah Health, Salt Lake City, Utah, United States
  • Kottey, Janame J., University of Utah Health, Salt Lake City, Utah, United States
  • Yadav, Niraj K., University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

AA amyloidosis due to deposition of serum amyloid A protein occurs as a secondary reaction to chronic inflammatory disease, chronic infections, and familial period fever syndromes. We present a case of AA amyloidosis secondary to chronic black tar Heroin use in the Intermountain West.

Case Description

A 61 yr. old Caucasian female with a history of Hepatitis C, IV Heroin use presented with bilateral leg pain, swelling, and abdominal distension. Examination was significant for ulceration in lower extremities with purulent blisters. Notable lab data include Hemoglobin of 8.2 g/dl, potassium of 6 meq/L, calcium of 10.6 mg/dl, BUN of 90 mg/dl, creatinine of 2.9 mg/dl, serum albumin of 2.1 g/dl, and ESR of 129 mm/hour. She had a urine protein to creatinine ratio of 12.3 g/g. Abdominal US revealed enlarged liver and normal renal echogenicity.

The quantification of HCV RNA by polymerase chain reaction was negative, and her complement levels were within normal range. Cryoglobulin was also negative with a kappa/lambda light chain ratio of 1.33. Serum protein electrophoresis showed decreased albumin and immunofixation electrophoresis showed a faint band in IgG kappa suggestive of a specific immune response or an early monoclonal protein.

Renal biopsy showed non-AL amyloid deposition involving glomeruli, and arteries. Mass spectrometry performed at Mayo Clinic Laboratories confirmed renal involvement by Amyloidosis, AA (serum amyloid A)-type.

Discussion

"Black tar heroin” has increasingly been identified as a risk factor for AA Amyloidosis. Impurities in heroin promote vascular sclerosis and lead to the use of injection into muscle and skin. The suppurative infections that follow stimulate the production of serum amyloid A protein with subsequent deposition in the kidney leading to nephrotic syndrome and end stage kidney disease. Greater awareness of this complication may help prevention in areas with increased black tar heroin use.

Renal biopsy