GRANULOMATOUS GLOMERULONEPHRITIS IN INTRAVENOUS-DRUG-USERS - A REPORTOF 3 CASES IN OXYCODONE ADDICTS

Various well-documented renal lesions are associated with intravenous drug use; however, intraglomerular mesangial granulomas have not been previously described. We report three patients who developed an unusua l granulomatous glomerulonephritis and interstitial nephritis after in travenous injection of oxycodone, derived from suppositories. Granulom as were seen in an intraglomerular mesangial and also interstitial loc ation. In both sites, the granulomas were associated with filamentous material, presumably derived from a component of the suppositories. Th is material was periodic acid-Schiff-positive, but negative with Congo red and silver stains. Ultrastructurally, the filamentous material wa s seen within the mesangial granulomas and also in a subendothelial lo cation, suggesting derivation from the circulation with subsequent tra nsport across the basement membrane and accumulation in the mesangium, where a granulomatous reaction was elicited, All patients developed a degree of renal failure; two of the patients require hemodialysis 20 and 30 months after presentation. Copyright (C) 1998 by W.B. Saunders Company.