Renal myoglobin in drug addicts: occurrence and significance in a postmortem study

Rhabdomyolysis in drug-related deaths

Background

This study aims to detect myoglobin staining in the cases in which were suspected that intoxication was the cause of death.

Materials and method

This study selected the drug-related death cases including those with toxic blood levels of substances. These drug-related death cases were classified into two groups: (1) suggestive of intoxication death group and (2) other causes of death group which was control group. The kidneys of all these cases were immunohistochemically stained with the myoglobin antibody for rhabdomyolysis diagnosis.

Results

There were 50 drug-related deaths separated into 28 study cases and 22 control cases. The positive myoglobin stain was found in 17 cases (60.7%) in the study group and 5 cases (22.7%) in the control group. The difference between two groups was statistically significant (p = 0.007).

Conclusions

Myoglobin detection in kidney by immunohistochemistry should be done to help for confirming the cause of deaths in these drug-related death cases.

Cocaine use and hypertensive renal changes in HIV-infected individuals

BACKGROUND AND OBJECTIVES

Cocaine causes kidney damage, but data linking cocaine use to chronic kidney disease in HIV patients is not described. This study was conducted to evaluate the possible association of cocaine use and histopathologic findings on biopsy in this population.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Kidney biopsies that were performed in HIV-infected patients during the course of 11 yr were reviewed. Demographic and clinical data were collected. Hypertensive changes were defined on the basis of the Banff 97 classification. Criteria of both arterial intimal fibrosis and thickening and hyaline arteriolosclerosis were used and graded as absent (0), mild (1), moderate (2), and severe (3). Hypertensive renal changes were considered present when the combined pathology score was > or = 2. To minimize confounding, those with hypertension or diabetes were excluded.

RESULTS

Of the 193 HIV patients who underwent kidney biopsy, 53 had no history of hypertension or diabetes with HIV infection. Of those, 29 (55%) had hypertensive renal changes on kidney biopsy. Cocaine use was present in 16 (55%) of 29 with hypertensive renal changes compared with six (25%) of 24 without hypertensive renal changes (odds ratio [OR] 3.7; 95% confidence interval [CI] 1.2 to 11.7). In the adjusted analyses, only age (/yr; OR 1.08; 95% CI 1.00 to 1.16) and cocaine use (OR 3.55; 95% CI 1.04 to 12.14) were significantly associated with hypertensive renal changes on renal biopsy.

CONCLUSIONS

Cocaine use is associated with hypertensive renal changes in HIV-infected patients in the absence of hypertension and diabetes.

Heroin-associated nephropathy

Since the first reports in the late 1960s and early 1970s there have been numerous studies describing the clinical and pathological features of renal diseases associated with chronic parenteral abuse of heroin, cocaine, morphine, amphetamine, and other narcotic and hallucinogenic drugs, including several adulterants. The past 35 years have witnessed an explosive growth in illicit drug use in many parts of the world. Meanwhile, drug addict nephropathy constitutes an important cause of end-stage renal disease. The term heroin-associated nephropathy' includes different morphological findings following chronic drug abuse. Up to now it still remains ambiguous as to whether or not heroin/morphine itself, adulterants, other diseases like hepatitis B and C infection, or HIV, lead to a spectrum of morphologically described heroin-associated' findings in the kidneys. As a measure of prevention it appears that the purity of heroin plays an important role.

Prevalence of rhabdomyolysis in drug deaths

Rhabdomyolysis has repeatedly been reported as a possible consequence of illicit drug consumption especially in clinical literature. In order to investigate the prevalence of rhabdomyolysis in cases of drug deaths, immunohistochemical staining of kidney sections with a myoglobin antibody was performed at 103 consecutive fatal drug poisonings. The control group consisted of 107 unselected forensic autopsies. With regard to the presence of intratubular myoglobin, 33% of the study group were categorized as "strongly positive", 17.5% as "slightly positive" and 49.5% as "negative". No single substance showed a particularly high incidence of rhabdomyolysis nor were there correlations to special combinations of substances. In the control group a "strongly positive" result after myoglobin staining was observed in only 10.3% of 107 cases, a "slightly positive" result in 13.1% and a "negative" result in 76.6%. The findings suggest that rhabdomyolysis is a frequent consequence of illicit drug consumption and that it is not promoted by a single factor, but by a combination of several factors.