Abstract: TH-PO1106
Renal AA Amyloidosis Associated with Xylazine-Related Wounds in People Who Inject Drugs: A Case Series
Session Information
- Pathology and Lab Medicine
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1700 Pathology and Lab Medicine
Authors
- Doan, Khanh Duy, Temple University, Philadelphia, Pennsylvania, United States
- Mollaee, Mehri, Temple University, Philadelphia, Pennsylvania, United States
- Hassler, Jared, Temple University, Philadelphia, Pennsylvania, United States
Background
Xylazine-adulterated fentanyl has emerged as a major contributor to severe soft tissue injury among people who inject drugs. Chronic wounds and recurrent infections may predispose to AA amyloidosis, yet renal outcomes in this population remain poorly described.
Methods
We conducted a retrospective case series of patients presenting with biopsy-proven renal AA amyloidosis (mas spectrometry) and documented xylazine-associated wounds. Demographic, clinical, laboratory, and infectious complication data were collected. Renal outcomes, including progression to end-stage renal disease (ESRD), were assessed.
Results
The cohort had 6 patients in total with a median age of 39 years, and 83.3% were male. Racial distribution was evenly divided among White, Black, and Hispanic patients. All participants reported intravenous fentanyl use, with frequent polysubstance use, including cocaine and methamphetamine. Patients presented with advanced kidney disease, characterized by a mean serum creatinine of 4.5 mg/dL, nephrotic-range proteinuria (mean 24-hour urine protein 11.4 g), and marked systemic inflammation (mean ESR 100.2 mm/hr). Hepatitis C virus infection was present in 83.3% of patients, while all tested negative for HIV and other sexually transmitted infections. Most patients had multiple chronic wounds; 66.7% had imaging evidence of osteomyelitis, and 50% had bacteremia with positive blood cultures. No cases of endocarditis were identified. Renal outcomes were poor, with 90% progressing to end-stage renal disease.
Conclusion
Xylazine-associated wounds are associated with marked systemic inflammation and high rates of infection, which may accelerate the development of AA amyloidosis and progression to end-stage renal disease. Early identification of chronic wounds, prompt and aggressive infection control, and harm-reduction strategies are essential to reduce renal morbidity in this high-risk population.