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Abstract: SA-PO938

Outcomes for Patients With Renal AA Amyloidosis Associated With Injection Heroin Use

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Johnson, Rachel R., American University of the Caribbean School of Medicine BV, Cupecoy, Sint Maarten (Dutch part)
  • Urisman, Anatoly, University of California San Francisco Department of Pathology, San Francisco, California, United States
  • Cho, Kerry C., University of California San Francisco Department of Medicine, San Francisco, California, United States
  • Sam, Ramin, Zuckerberg San Francisco General Hospital and Trauma Center Department of Medicine, San Francisco, California, United States
  • Wong, Sandy W., University of California San Francisco Department of Medicine, Division of Hematology and Oncology, San Francisco, California, United States
Background

AA amyloidosis is a rare but serious complication of chronic inflammation. Skin popping is a common practice among heroin users in the western United States and an under-studied cause of renal AA amyloidosis (R-AA). We performed a multicenter retrospective analysis of R-AA due to injection heroin use (IHU) in San Francisco (SF).

Methods

Patients with biopsy-proven R-AA were identified at UCSF and SF General Hospital between 1/1/2000 and 6/30/2021 under an IRB-approved study. Only patients with R-AA from IHU were included. Data for these patients including baseline characteristics, renal survival, and overall survival were abstracted from the medical records. Overall survival (OS), renal survival (RS) and time-to-dialysis (TTD) were summarized using Kaplan-Meier methods via GraphPad Prism 9.3.1.

Results

Sixty-seven subjects with biopsy-proven R-AA were identified, of which 55 had adequate medical records available to determine the underlying etiology. All R-AA biopsies must have had Congo Red positivity and amyloid typing by SAA positivity or mass spectrometry to be included. Of these 55 cases, 45 (82%) were attributable to IHU.

For patients with R-AA due IHS, the median age was 50 (range 24-70), 9 (20%) were female, 31 (69%) were Caucasian, 40 (89%) were non-Hispanic. At diagnosis, 82% had a history of skin abscess or skin ulceration related to IHU. Eighty-nine percent also had hepatitis C, 24% hepatitis B and 20% HIV.

Twelve (27%) patients with R-AA from IHU were dialysis-dependent at the time of diagnosis. Thirty-three patients (73%) were dialysis-independent at diagnosis with a median eGFR of 13 ml/min/1.73m2 (range 3 - >60) and a median protein/creatinine ratio of 8440 mg/g creat (range 380-48,280). Of these patients, 17 eventually required dialysis. Median RS and TTD for this cohort was 1.9 years and 6.7 weeks respectively. None of the patients who required dialysis came off dialysis. After cessation of IHU, 1 patient received a renal allograft with a renal allograft survival of 6 years.

The median OS for patients with R-AA was 2.8 years. Median follow-up was 5.0 years.

Conclusion

The leading cause of R-AA in SF is IHS. R-AA patients often have concomitant infections such as hepatitis and HIV. R-AA is associated with high rates of dialysis-dependence and mortality.