Intravenous drug use and glomerular deposition of lipid-like material

We present a series of 5 intravenous drug users (4 male, age range 24-47 years) with glomerular deposition of a lipid-like material. Three patients presented with the nephrotic syndrome, 1 with acute renal failure and 1 with hypertension and an active urinary sediment. All were continuing to use opiates intravenously (mixed with lemon juice or acetic anhydride and sodium bicarbonate).

plasma creatinine 0.10-0.30 mmol/l, urinary protein excretion 1.0-6.75 g/24 h, hepatitis C antibody positive (4), all seronegative for hepatitis B and HIV. Renal biopsy showed large vacuolated areas consistent with heavy deposition of lipid-like material in all glomerular cells and infiltrating macrophages. Two showed ATN and another FGS. We suggest that these changes are due to the pattern of illicit drug availability and preparation peculiar to these users.