Recurrent nephropathy associated with heroin use

Heroin addicts have been reported to develop glomerular sclerosis and progressive renal insufficiency. The pathogenesis of this lesion had not been determined, and the observation has been disputed. We report a patient, followed for 10 years, who developed relapsing nephrotic syndrome after intermittent heroin use. Although the first and second kidney biopsies showed minimal glomerular change, the third kidney biopsy showed granular, mesangial IgM deposits on immunofluorescent microscopy. Mild diminution of renal function was also seen. Heroin use, in this patient, can be directly related to episodic nephrotic syndrome and a slowly progressive glomerular disease.