Miscellaneous complications

Charles v. Wetli, m.d. Suffolk County Medical Examiner, Happauge, New York

The most frequently encountered renal abnormality among drug abusers seen today is myoglobinuric nephrosis secondary to cocaine-induced rhabdomyolysis. These are frequently seen in victims of drug-induced excited delirium accompanied by hyperpyrexia and intense muscular activity.1 Survival for several days reveals, at autopsy, massive necrosis of skeletal muscle which is easily identified because of its distinctive yellow (instead of dark brown) coloration.2 These deaths are invariably marked by pronounced elevations in serum creatine kinase, profound hypotension, and disseminated intravascular coagulation. Abuse of stimulant drugs has also been associated with renal artery thrombosis and infarction, and renal vasculitis.1 Maternal cocaine abuse has been associated with a plethora of fetal anomalies, most notably urogenital abnormalities such as hydronephrosis and atresia of the distal ureters.1

Heroin addicts may develop the nephrotic syndrome secondary to bacterial endocarditis, renal amyloidosis, or heroin-associated nephropathy (HAN). The latter is characterized by focal segmental (occasionally global) glomerulosclerosis.1 The etiology is probably immuno-logic, but there is also evidence favoring an ischemic glomerulopathy.3

Liver damage from drug abuse is often related to direct drug toxicity, allergic or idiosyncratic reactions, or various forms of hepatitis.4 Alcohol-induced fatty change, alcoholic hepatitis and cirrhosis are well-known entities which may exacerbate the effects of other drugs of abuse taken concomittantly. Hepatic damage from cocaine has been induced in laboratory animals5 but does not appear to occur in humans.1,6 Intravenous heroin addiction has been associated with a sometimes intense lymphoid infiltrate (occasionally with germinal centers) of the portal zones,7 often referred to as "triaditis". This appears to be independent of viral hepatitis and may represent an immunologic phenomenon. These infiltrates are, however, not invariable with intravenous drug abusers and may be seen in apparently normal people (but usually to a lesser degree). Another nonspecific but fairly typical finding in heroin addicts is mild to moderate hepatosplenomegaly, sometimes associated with enlarged lymph nodes of the porta hepatis or celiac axis, and lymphoid hyperplasia of the spleen.7

The pathology of drug abuse will continue to evolve as people continue to abuse drugs over the years. The long term cardiovascular damage from chronic cocaine abuse is coming into focus, and other organ damage (e.g., of the central nervous system) may become apparent in the years to come. Drugs are constantly being rediscovered and wax and wane in recreational popularity; other drugs appear which are new. All have, or will have, the potential for severe morbidity and death through behavioral modification, acute toxicity and overdose, and long term functional and structural damage to the body. Unfortunately, it takes years and many fatalities before the pathology of newly abused drugs becomes evident.

Defeat Drugs and Live Free

Defeat Drugs and Live Free

Being addicted to drugs is a complicated matter condition that's been specified as a disorder that evidences in the obsessional thinking about and utilization of drugs. It's a matter that might continue to get worse and become disastrous and deadly if left untreated.

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