A patient who chronically abuses heroin may develop a nephropathy with proteinuria.


Clinical findings:

(1) history of chronic heroin addiction, typically for more than 1 year

(2) proteinuria, ranging from mild to nephrotic level (from 1 to 30 grams per 24 hours)

(3) with or without renal insufficiency; if renal insufficiency develops then the patient will often progress to end-stage renal disease and require dialysis or renal transplant

(4) reversal possible if heroin is discontinued, with recurrence if abuse is restarted


Glomerular changes on renal biopsy are variable and may include:

(1) focal glomerular sclerosis

(2) focal or diffuse membranous glomerulopathy

(3) proliferative glomerulonephritis

(4) membranoproliferative glomerulonephritis


Conditions that may be concurrent or in the differential diagnosis:

(1) HIV nephropathy

(2) renal amyloidosis

(3) acute renal failure due to rhabdomyolysis

(4) glomerulopathy associated with viral hepatitis

(5) diabetic nephropathy


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