A case of acute-on-chronic renal failure is presented that is the sequela of secondary (AA) amyloidosis in a hepatitis positive intravenous drug user (IVDU) with chronic venous ulceration. The importance of groin examination is stressed when upper limb veins in a suspected IVDU are normal. Recent epidemiological data is discussed that suggests geographical location and the subcutaneous (SC) route of drug administration are both contributing factors to the development of AA amyloidosis and not chronic infection with HIV, HBV or HCV.