Glomerular lipid deposition: a clue to illicit intravenous drug use.

摘要

Acute renal failure due to intravenous drug use (IVDU) is not uncommon. However, a history of IVDU is not always obvious, forthcoming or volunteered. In a subgroup of patients, a clue indicating IVDU may be observed in the renal biopsy. A 42-year-old woman presented with 3 days of fever and dyspnoea. She had a history of stable hepatitis C infection, depression and chronic lower-back pain. Her medications included mirtazapine, paracetamol/codeine and slow-release morphine sulfate. She was febrile (38degC), tachycardic (130/ min) and in respiratory failure (PaO_2 60 mm Hg). Chest X-ray demonstrated diffuse pulmonary infiltrates. Initial tests showed, anaemia (haemoglobin 73 g/L), elevated white cell count (16.2L), renal impairment (creatinine 148 (imol/L) and high inflammatory markers (CRP 293 mg/L, ESR 47 mm/hr). Serum albumin was low (19 g/L) but liver transaminases were normal.