Clinical significance of antinuclear antibodies, anti-neutrophil cytoplasmic antibodies and anticardiolipin antibodies in heroin abusers.

BACKGROUND: Different autoantibodies and immunologic abnormalities have been described in heroin abusers positive for human immunodeficiency virus, hepatitis B surface antigen, or hepatitis C virus, as well as in addicts with negative viral markers. OBJECTIVES: To investigate the prevalence of different autoantibodies in heroin addicts. METHODS: We studied 10 heroin addicts (8 males and 2 females aged 18-30 years) with a mean duration of heroin abuse of 46.5 months (range 6-96) for the presence of the following autoantibodies: antinuclear antibodies and anti-neutrophil cytoplasmic antibodies--using indirect immunofluorescent technique; ds-DNA, ss-DNA, Sm, RNP, Ro and La antibodies--using counter immunoelectrophoresis; and immunoglobulins G and M anticardiolipin and beta 2-glycoprotein-I antibodies--using enzyme-linked immunosorbent assay. All patients were tested for VDRL, HIV, HBsAG and anti-HCV antibodies. RESULTS: Four patients were positive for ANA, of whom two were positive for anti-HCV and two for ANCA. Three patients were positive for IgM aCL, one of whom was positive for IgG beta 2 GPI with clinical data of acute renal failure in the course of heroin coma and antiphospholipid syndrome (deep vein thrombosis) and positive Sm and ds-DNA antibodies, and another had subacute endocarditis and biopsy-proven chronic tubulo-interstitial nephritis (in both these patients aCL gradually fell to normal levels after the cessation of heroin abuse). One patient was HBsAG positive with negative autoantibodies. All patients were HIV and VDRL negative. CONCLUSION: Our data support the importance of ANA and aCL determination as a predictor of some systemic complications in heroin addicts.

Renal Doppler ultrasound in patients with hypertension and metabolic syndrom.

Evaluation of the renal changes by conventional and Doppler ultrasound (US) was performed in patients with hypertension and obesity. 67 persons were examined and divided in 3 groups. Group I includes 27 patients--15 M and 12 F, average age 52+/-4.87 with well controlled diabetes mellitus type II and hypertension, Ccr.--139+/-1.31. Group II includes 20 patients--9 M and 11 F, average age 53+/-7 with well controlled hypertension without diabetes, with Ccr 128+/-7.8. Group III--20) pts. 8 F and 12 M, average age 54+/-5 with uncontrolled hypertension without diabetes, with Ccr 128+/-7.8. All examined pts. were with BMI>30 and hyperlipidemia--total cholesterol>6.5 mmol/l. Tests for microalbuminuria were negative in all 3 groups. In all three groups, using conventional US, the following parameters were detected by Aloca 4000 machine: renal (RV) and parenchyma (PV) volumes as well as Doppler parameters RI, PI, Vmax, Vmin, and Vmean. There were no significant differences between RV and PV of all examined groups: Group I--254+/-53, Group II--238+/-38, Group III--263+/-38, p=0.1. The strong correlation between renal volumes and BMI was found (Pearson's r 0.58). There were no significant differences between Vmax, Vmin, Vmean in all three groups. RI is normal <0.7 in all examined patients: Group I--0.63+/-0.06, Group II--0.61+/-0.02, Group III--0.66+/-0.03. RI in group III was significantly higher, p<0.05 compared to RI indices detected in other two groups but remains at normal levels. Intrarenal hemodynamics exhibited no difference in all examined groups. Analysis of the Doppler spectrum of the intrarenal arteries provides an accurate information about renal vascular changes but has no significant advantages in patients with hypertension and obesity with normal renal function and signs of hypertensive nephropathy "benign nephrosclerosis". Nevertheless Duplex Doppler Ultrasound is a noninvasive method which is an important part of the diagnostic algorithm in patients with diseases characterized by vascular involvement such as hypertension.