Severe chronic renal failure in association with oxycodone addiction: a new form of fibrillary glomerulopathy

A number of well-documented renal lesions have been associated with intravenous drug use. Recently, investigators reported three cases of granulomatous glomerulonephritis in association with intravenous injection of oxycodone suppositories. We report 2 patients with similar glomerular pathology who presented with chronic renal failure. However, we also highlight the widespread tubulointerstitial involvement in this renal lesion. The fibrillar deposits seen within the glomeruli and extensively within tubular basement membranes on electron microscopy do not have the staining characteristics of amyloid and are not associated with immunoglobulin (Ig) deposition. Is this a new form of non-Ig-associated fibrillary glomerulopathy with its pathogenesis linked to some component of the oxycodone suppositories? One of the patients had a history of narcotic addiction but denied intravenous injection of suppositories. In both patients there was progressive deterioration of renal function with 1 patient requiring dialysis within 3 months of initial presentation.