Renal Involvement in Drug Abuse

Renal changes in 14 drug addicts were studied. Five patients had nephrotic syndrome, five had bacterial endocarditis, and four had acute viral hepatitis. On light microscopy, increase in PAS-positive material in the mesangial area was observed in all patients. Immunofluorescent staining showed IgG, IgM, and β₁C as discrete focal nodular deposits in the glomerular capillary loops. Electron microscopy disclosed focal basement-membrane thickening and deposition of homogeneous, finely granular electrondense material in all patients. Endothelial cytoplasmic inclusions of tubular structures similar to the "virus-like" particles of lupus erythematosus were present in 12 of the biopsy specimens. In drug addicts, the repeated parenteral introduction of antigenic material of microbial, viral, or pharmacologic origin appears to initiate an immunologic process that results in renal damage secondary to immune complex deposits.