1
|
Yasir S, Chen ZE, Hartley C, Zhang L, Torbenson M. Morphological findings in different subtypes of hepatic amyloid. Hum Pathol 2024; 146:35-42. [PMID: 38460799 DOI: 10.1016/j.humpath.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
The classic findings have been well described for light-chain amyloid involving the liver. In addition to light chain, however, many additional proteins are now known to be amyloidogenic and can involve the liver. A total of 58 surgical pathology specimens with amyloid deposits were analyzed for patterns of amyloid deposition, including amyloid from light chain lambda (N = 17), light chain kappa (N = 15), transthyretin (N = 15), serum amyloid A (N = 4), apolipoprotein A1 (N = 4), fibrinogen alpha (N = 2), LECT2 (N = 1). Amyloid deposits predominately targeted the liver vasculature, including the walls of the hepatic arteries, portal veins, and sinusoids. While there was overlap, light chain amyloid predominately involved the sinusoids, while transthyretin amyloid predominately targeted the hepatic arteries, especially the larger ones in the hilum and larger portal tracts. Serum amyloid A formed nodular deposits that started in the portal vasculature but then extended into the portal tract stroma, leading to large, bulbous, portal-based amyloid deposits. Apolipoprotein A amyloid also formed large portal-based nodules. Fibrinogen was mild and subtle on H&E and predominately affected portal veins. Amyloid deposits in hilar nerves were prominent with amyloid light chain, transthyretin, and apolipoprotein A1. In conclusion, the histology of hepatic amyloid is diverse and shows several distinct clusters of findings that can aide in recognition in surgical pathology specimens.
Collapse
Affiliation(s)
- Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Zongming Eric Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Chris Hartley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lizhi Zhang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Anand SK, Sanchorawala V, Verma A. Systemic Amyloidosis and Kidney Transplantation: An Update. Semin Nephrol 2024:151496. [PMID: 38490903 DOI: 10.1016/j.semnephrol.2024.151496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Amyloidosis is a heterogeneous disorder characterized by abnormal protein aggregate deposition that often leads to kidney involvement and end-stage kidney disease. With advancements in diagnostic techniques and treatment options, the prevalence of patients with amyloidosis requiring chronic dialysis has increased. Kidney transplantation is a promising avenue for extending survival and enhancing quality of life in these patients. However, the complex and heterogeneous nature of amyloidosis presents challenges in determining optimal referral timing for transplantation and managing post-transplantation course. This review focuses on recent developments and outcomes of kidney transplantation for amyloidosis-related end-stage kidney disease. This review also aims to guide clinical decision-making and improve management of patients with amyloidosis-associated kidney disease, offering insights into optimizing patient selection and post-transplant care for favorable outcomes.
Collapse
Affiliation(s)
- Shankara K Anand
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Section of Hematology and Oncology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Ashish Verma
- Renal Section, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Amyloidosis Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA.
| |
Collapse
|
3
|
Andeen NK, DiFranza L, Kung VL, Henriksen K, Gupta R, Dinesh K, Akilesh S, Kudose S, Smith KD, Troxell ML. AA amyloidosis With Ig-Dominant Staining and Diagnostically Unusual Features. Kidney Int Rep 2024; 9:162-170. [PMID: 38312779 PMCID: PMC10831352 DOI: 10.1016/j.ekir.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Although serum amyloid A (AA) amyloid may occasionally show nonspecific staining by immunofluorescence (IF), the correct diagnosis can usually be determined by integrating pathologic features and clinical scenario, and using AA amyloid immunohistochemistry (IHC) and/or mass spectrometry. A recent mass spectrometry-based study described false-positive Ig IF staining in a subset of AA amyloid cases. Methods We sought to delineate clinicopathologic features of AA amyloid with Ig-dominant staining by using a retrospective review. Results AA amyloid with Ig-dominant staining was identified in 10 patients from 5 institutions, representing 1.2% to 4% of AA amyloid kidney biopsies. Evidence of a monoclonal protein was documented in 0% to 2.7% of patients with AA amyloid screened for inclusion, but 30% of those with Ig-dominant staining. The patient population had equal sex distribution and presented at median age of 68.5 years with nephrotic proteinuria and kidney impairment. Etiologies of AA amyloid included injection drug use (30%), autoimmune disease (20%), and chronic infection (10%); 40% had no identified clinical association. On biopsy, heavy chain (co)dominant staining by IF (in 80%), discordant distribution in Ig staining (in 20%), tubulointerstitial nephritis (in 30%), and/or crescents (in 10%) were present. Two of 3 patients with paraproteinemia had concordant heavy and/or light chain dominant staining within the AA amyloid. Two cases were initially misdiagnosed as Ig-associated amyloidosis. Conclusion We describe the morphologic spectrum of AA amyloidosis with Ig-dominant staining which may have clinical, laboratory, and pathologic overlap with amyloid light chain (AL), amyloid heavy chain, and heavy and light chain (AHL) amyloidosis.
Collapse
Affiliation(s)
- Nicole K. Andeen
- Department of Pathology and Laboratory Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Lanny DiFranza
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vanderlene L. Kung
- Department of Pathology and Laboratory Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kammi Henriksen
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Renu Gupta
- Renal Care Consultants, Medford, Oregon, USA
| | | | - Shreeram Akilesh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kelly D. Smith
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Megan L. Troxell
- Department of Pathology, Stanford University, Stanford, California, USA
| |
Collapse
|
4
|
Kashiv P, Dubey S, Sejpal KN, Gurjar P, Mahajan V, Pasari A, Balwani M. Nephrotic Syndrome in a Retroviral Disease Due to AA Amyloidosis: A Rare Presentation. Cureus 2023; 15:e44928. [PMID: 37818496 PMCID: PMC10560608 DOI: 10.7759/cureus.44928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Kidney disease poses a significant burden on individuals with HIV infection. In the pre-ART era, HIV-associated nephropathy (HIVAN) was the most common renal pathology identified in individuals with HIV. However, the widespread use of ART has led to changes in the spectrum of renal pathologies associated with HIV. HIV infection is an unclear cause of AA amyloidosis. Here, we report a rare case of an HIV-positive patient presenting with nephrotic syndrome which turned out to be AA amyloidosis on renal biopsy.
Collapse
Affiliation(s)
- Pranjal Kashiv
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Dubey
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kapil N Sejpal
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Gurjar
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Mahajan
- Department of Pathology, Alexis Multispecialty Hospital, Nagpur, IND
| | - Amit Pasari
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
5
|
Karam S, Haidous M, Royal V, Leung N. Renal AA amyloidosis: presentation, diagnosis, and current therapeutic options: a review. Kidney Int 2023; 103:473-484. [PMID: 36502873 DOI: 10.1016/j.kint.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
Amyloid A amyloidosis is thought to be the second most common form of systemic amyloidosis behind amyloidosis secondary to monoclonal Ig. It is the result of deposition of insoluble fibrils in the extracellular space of tissues and organs derived from the precursor protein serum amyloid A, an acute phase reactant synthesized excessively in the setting of chronic inflammation. The kidney is the most frequent organ involved. Most patients present with proteinuria and kidney failure. The diagnosis is made through tissue biopsy with involvement of the glomeruli in most cases, but also often of the vessels and the tubulointerstitial compartment. The treatment usually targets the underlying etiology and consists increasingly of blocking the inflammatory cascade of cytokines with interleukin-1 inhibitors, interleukin-6 inhibitors, and tumor necrosis factor-α inhibitors to reduce serum amyloid A protein formation. This strategy has also shown efficacy in cases where an underlying etiology cannot be readily identified and has significantly improved the prognosis of this entity. In addition, there has been increased interest at developing effective therapies able to clear amyloid deposits from tissues, albeit with mitigated results so far.
Collapse
Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Mohamad Haidous
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Virginie Royal
- Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA; Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
6
|
Biederman LE, Dasgupta AD, Dreyfus DE, Nadasdy T, Satoskar AA, Brodsky SV. Kidney Biopsy Corner: Amyloidosis. GLOMERULAR DISEASES 2023; 3:165-177. [PMID: 37901698 PMCID: PMC10601942 DOI: 10.1159/000533195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023]
Abstract
Amyloidosis is an infiltrative disease caused by misfolded proteins depositing in tissues. Amyloid infiltrates the kidney in several patterns. There are, as currently described by the International Society of Amyloidosis, 14 types of amyloid that can involve the kidney, and these types may have different locations or clinical settings. Herein we report a case of AA amyloidosis occurring in a 24-year-old male with a history of intravenous drug abuse and provide a comprehensive review of different types of amyloids involving the kidney.
Collapse
Affiliation(s)
- Laura E. Biederman
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Alana D. Dasgupta
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | - Tibor Nadasdy
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Anjali A. Satoskar
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Sergey V. Brodsky
- Department of Pathology, Ohio State Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
7
|
Fedotov SA, Khrabrova MS, Anpilova AO, Dobronravov VA, Rubel AA. Noninvasive Diagnostics of Renal Amyloidosis: Current State and Perspectives. Int J Mol Sci 2022; 23:ijms232012662. [PMID: 36293523 PMCID: PMC9604123 DOI: 10.3390/ijms232012662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Amyloidoses is a group of diseases characterized by the accumulation of abnormal proteins (called amyloids) in different organs and tissues. For systemic amyloidoses, the disease is related to increased levels and/or abnormal synthesis of certain proteins in the organism due to pathological processes, e.g., monoclonal gammopathy and chronic inflammation in rheumatic arthritis. Treatment of amyloidoses is focused on reducing amyloidogenic protein production and inhibition of its aggregation. Therapeutic approaches critically depend on the type of amyloidosis, which underlines the importance of early differential diagnostics. In fact, the most accurate diagnostics of amyloidosis and its type requires analysis of a biopsy specimen from the disease-affected organ. However, absence of specific symptoms of amyloidosis and the invasive nature of biomaterial sampling causes the late diagnostics of these diseases, which leads to a delayed treatment, and significantly reduces its efficacy and patient survival. The establishment of noninvasive diagnostic methods and discovery of specific amyloidosis markers are essential for disease detection and identification of its type at earlier stages, which enables timely and targeted treatment. This review focuses on current approaches to the diagnostics of amyloidoses, primarily with renal involvement, and research perspectives in order to design new specific tests for early diagnosis.
Collapse
Affiliation(s)
- Sergei A. Fedotov
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg 199034, Russia
| | - Maria S. Khrabrova
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Research Institute of Nephrology, Pavlov University, St. Petersburg 197101, Russia
| | - Anastasia O. Anpilova
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Research Institute of Nephrology, Pavlov University, St. Petersburg 197101, Russia
| | | | - Aleksandr A. Rubel
- Laboratory of Amyloid Biology, St. Petersburg State University, St. Petersburg 199034, Russia
- Department of Genetics and Biotechnology, St. Petersburg State University, St. Petersburg 199034, Russia
- Correspondence: ; Tel.: +7-812-428-40-09
| |
Collapse
|
8
|
Thorne J, Clark D, Geldenhuys L, More K, Vinson A, Tennankore K. Serum Amyloid A Protein–Associated Kidney Disease: Presentation, Diagnosis, and Management. Kidney Med 2022; 4:100504. [PMID: 35879979 PMCID: PMC9307948 DOI: 10.1016/j.xkme.2022.100504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Serum amyloid A protein (AA) amyloidosis, also known as secondary amyloidosis, is a known consequence of chronic inflammation and results from several conditions including inflammatory arthritis, periodic fever syndromes, and chronic infection. AA amyloidosis can lead to multiorgan dysfunction, including changes in glomerular filtration rate and proteinuria. Definitive diagnosis requires tissue biopsy, and management of AA amyloid kidney disease is primarily focused on treating the underlying inflammatory condition to stabilize glomerular filtration rate, reduce proteinuria, and slow potential progression to kidney failure. In this narrative review, we describe the causes, pathophysiology, presentation, and pathologic diagnosis of AA amyloid kidney disease using an illustrative case of biopsy-proven AA amyloid kidney disease in a patient with long-standing rheumatoid arthritis who had a favorable response to interleukin 6 inhibition. We conclude the review with a description of established and more novel therapies for AA amyloidosis including published cases of use of tocilizumab (an interleukin 6 inhibitor) in biopsy-proven AA amyloid kidney disease.
Collapse
Affiliation(s)
- Jordan Thorne
- Department of Medicine, Dalhousie University and Nova Scotia Health
- Address for Correspondence: Jordan Thorne, MD, Department of Medicine, Dalhousie University and Nova Scotia Health, 1276 South Park St, Halifax, NS B3H 2Y9, Canada.
| | - David Clark
- Department of Medicine, Dalhousie University and Nova Scotia Health
- Division of Nephrology, Nova Scotia Health
| | - Laurette Geldenhuys
- Division of Nephrology, Nova Scotia Health
- Department of Pathology, Dalhousie University and Nova Scotia Health
| | - Keigan More
- Department of Medicine, Dalhousie University and Nova Scotia Health
- Division of Nephrology, Nova Scotia Health
| | - Amanda Vinson
- Department of Medicine, Dalhousie University and Nova Scotia Health
- Division of Nephrology, Nova Scotia Health
| | - Karthik Tennankore
- Department of Medicine, Dalhousie University and Nova Scotia Health
- Division of Nephrology, Nova Scotia Health
| |
Collapse
|
9
|
Eyal O, Shinar Y, Pras M, Pras E. Familial Mediterranean fever: Penetrance of the p.[Met694Val];[Glu148Gln] and p.[Met694Val];[=] genotypes. Hum Mutat 2020; 41:1866-1870. [DOI: 10.1002/humu.24090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Ori Eyal
- The Danek Gertner Institute of Human Genetics Sheba Medical Center, Tel‐Hashomer Ramat Gan Israel
- St George's, University of London MBBS Program at Sheba Medical Center Tel‐Hashomer Israel
| | - Yael Shinar
- FMF Clinic and the Heller Institute of Medical Science Sheba Medical Center, Tel‐Hashomer Ramat Gan Israel
| | - Mordechai Pras
- FMF Clinic and the Heller Institute of Medical Science Sheba Medical Center, Tel‐Hashomer Ramat Gan Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Elon Pras
- The Danek Gertner Institute of Human Genetics Sheba Medical Center, Tel‐Hashomer Ramat Gan Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| |
Collapse
|
10
|
Abstract
From a clinical perspective, there is a need for a reliable and comprehensive list of diseases causing AA amyloidosis. This list could guide clinicians in the evaluation of patients with AA amyloidosis in whom an obvious cause is lacking. In this systematic review, a PubMed, Embase and Web of Science literature search were performed on causes of AA amyloidosis published in the last four decades. Initially, 4066 unique titles were identified, but only 795 full-text articles and letters were finally selected for analysis. Titles were excluded because of non-AA type of amyloidosis, language, no full-text publication or irrelevance. Hundred and fifty diseases were initially reported to be associated with the development of AA amyloidosis. The presence of AA amyloid was proven in 208 articles (26% of all) of which 140 (67%) showed a strong association with an underlying disease process. Disease associations were categorized and 48 were listed as strong, 19 as weak, 23 as unclear, and 60 as unlikely. Most newly described diseases are not really unexpected because they often cause longstanding inflammation. Based on the spectrum of identified causes, a pragmatic diagnostic approach is proposed for the AA amyloidosis patient in whom an obvious underlying disease is lacking.
Collapse
Affiliation(s)
- Anne Floor Brunger
- Departments of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Amyloidosis Center of Expertise, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans L A Nienhuis
- Amyloidosis Center of Expertise, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johan Bijzet
- Departments of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Amyloidosis Center of Expertise, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bouke P C Hazenberg
- Departments of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Amyloidosis Center of Expertise, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
11
|
Taşdemir M, Yılmaz S, Baba ZF, Bilge I. A rare cause of AA amyloidosis and end-stage kidney failure: Answers. Pediatr Nephrol 2019; 34:1537-1539. [PMID: 30456664 DOI: 10.1007/s00467-018-4153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mehmet Taşdemir
- Division of Pediatric Nephrology, Department of Pediatrics, Koç University School of Medicine, Davutpaşa cad no: 4 Topkapı, 34010, Istanbul, Turkey.
| | - Sezen Yılmaz
- Koç University School of Medicine, Istanbul, Turkey
| | | | - Ilmay Bilge
- Division of Pediatric Nephrology, Department of Pediatrics, Koç University School of Medicine, Davutpaşa cad no: 4 Topkapı, 34010, Istanbul, Turkey
| |
Collapse
|
12
|
Rheumatoid arthritis revealed by polyadenopathy, diarrhea and digestive AA amyloidosis. Joint Bone Spine 2019; 86:397-398. [DOI: 10.1016/j.jbspin.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/20/2018] [Indexed: 11/19/2022]
|
13
|
Yaghubi M, Dinpanah H, Ghanei-Motlagh F, Kakhki S, Ghasemi R. Trifascicular block as primary presentation of the cardiac amyloidosis; A rare case report. ARYA ATHEROSCLEROSIS 2018; 14:101-104. [PMID: 30108642 PMCID: PMC6087624 DOI: 10.22122/arya.v14i2.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Amyloidosis is a severe systemic disorder produces by the accumulation of inappropriately amyloid deposition in tissues. Cardiac involvement, as a main type of amyloidosis, has a major impact on prognosis. We describe a biopsy-proven cardiac amyloidosis in an old man with unexpected presentation. CASE REPORT A 70-year-old man, with a complaint of severe weakness, lightheadedness, and lower limb paresthesia, was admitted to the emergency department. Electrocardiography revealed right bundle branch block and Trifascicular block. Echocardiography study showed a moderately increased thickness of left ventricular wall with concentric pattern as well. Laboratory investigations including serum and urine electrophoresis, and serum free light chain examination as immunofixation assay revealed that κ chains predominated over λ chains in a ratio of 3:2. Our patient with final diagnosis of amyloid light-chain (AL) amyloidosis underwent chemotherapy with melphalan combined with high-dose dexamethasone, CPHPC and monoclonal antibodies for 2 weeks. CONCLUSION It shows that rapid diagnosis of AL amyloidosis can enhance the prognosis. Applying an optimal strategy for the treatment leads to effective therapy, too.
Collapse
Affiliation(s)
- Mohsen Yaghubi
- MSc Student, Student Research Committee AND Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Dinpanah
- Assistant Professor, Department of Emergency, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fahimeh Ghanei-Motlagh
- Department of Obstetrics and Gynecology, Dey 9th Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Samaneh Kakhki
- Assistant Professor, Department of Pharmacology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Reza Ghasemi
- Assistant Professor, Department of Cardiology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| |
Collapse
|
14
|
Yılmaz S, Tekgöz E, Çınar M. Recurrence of proteinuria after cessation of tocilizumab in patients with AA amyloidosis secondary to FMF. Eur J Rheumatol 2018; 5:278-280. [PMID: 30071938 PMCID: PMC6267750 DOI: 10.5152/eurjrheum.2018.17183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/10/2018] [Indexed: 11/25/2022] Open
Abstract
There is no established treatment protocol for amyloid-A (AA) amyloidosis secondary to Familial Mediterranean Fever (FMF). Recently, we reported the efficacy of tocilizumab in 11 amyloidosis cases associated with FMF. In 2 patients of 11, we discontinued the tocilizumab administeration owing to the normalization of amyloidosis-related symptoms, but proteinuria re-occurred eventually. Fortunately, the patients responded to tocilizumab re-treatment. This led us to conclude that physicians should not stop the treatment, even in patients with normalized proteinuria levels.
Collapse
Affiliation(s)
- Sedat Yılmaz
- Division of Rheumatology, Department of Internal Medicine, Health Sciences University Gülhane School of Medicine, Ankara, Turkey
| | - Emre Tekgöz
- Division of Rheumatology, Department of Internal Medicine, Health Sciences University Gülhane School of Medicine, Ankara, Turkey
| | - Muhammet Çınar
- Division of Rheumatology, Department of Internal Medicine, Health Sciences University Gülhane School of Medicine, Ankara, Turkey
| |
Collapse
|
15
|
Sharma A, Govindan P, Toukatly M, Healy J, Henry C, Senter S, Najafian B, Kestenbaum B. Heroin Use Is Associated with AA-Type Kidney Amyloidosis in the Pacific Northwest. Clin J Am Soc Nephrol 2018; 13:1030-1036. [PMID: 29907621 PMCID: PMC6032593 DOI: 10.2215/cjn.13641217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/17/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES AA-type kidney amyloidosis is classically associated with chronic autoimmune or inflammatory disorders. However, some urban centers have reported a high prevalence of injection drug use among patients with kidney AA amyloidosis. Previous reports lack control groups to quantify associations and most predate the opioid epidemic in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a case-control study of 38 patients with biopsy-confirmed kidney AA amyloidosis and 72 matched control individuals without this condition from two large hospital systems in Seattle, Washington. We ascertained the pattern and duration of heroin use by medical chart review and determined associations using logistic regression. RESULTS Among case patients, 95% had a prior history of heroin use, 87% had skin abscesses, and 76% and 27% had evidence of muscling and skin popping, respectively. After adjustment for age, race, sex, site, and year of biopsy, any heroin use (past or current) was associated with an estimated 170-times higher risk of kidney AA amyloidosis compared with no heroin use (95% confidence interval, 28 to 1018 times higher; P<0.001). Chronic autoimmune disorders were uncommon among case patients in this study. The median time to ESKD among patients with AA amyloidosis was 2.4 years (interquartile range, 0.5-7.5 years). CONCLUSIONS Injection heroin use is strongly associated with kidney AA amyloidosis in the Pacific Northwest. Unique aspects of heroin use, in particular geographic regions or frequent associated soft-tissue infections, may be an important cause of this progressive kidney disease.
Collapse
Affiliation(s)
| | | | | | | | | | - Steve Senter
- Institute for Translational Health Sciences, University of Washington, Seattle, Washington
| | | | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine
- Kidney Research Institute, and
| |
Collapse
|
16
|
Erdogmus S, Kendi Celebi Z, Akturk S, Kumru G, Duman N, Ates K, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Keven K. Profile of renal AA amyloidosis in older and younger individuals: a single-centre experience. Amyloid 2018; 25:115-119. [PMID: 29775082 DOI: 10.1080/13506129.2018.1474733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE In epidemiological studies of amyloid A (AA) amyloidosis from Turkey, the most frequently cause was familial Mediterranean fever (FMF) and it occurs generally in young age population. However, there are no sufficient data regarding aetiology, clinical presentation and prognosis of renal AA amyloidosis in advanced age patients. In this study, we aimed to investigate demographic, clinical presentation, aetiology and outcomes of adults aged 60 years or older patients with biopsy-proven renal AA amyloidosis. METHODS This is a retrospective study involving 53 patients who were diagnosed with AA amyloidosis by kidney biopsy from 2006 to 2016. In all patients, kidney biopsies were performed due to asymptomatic proteinuria, nephrotic syndrome and/or renal insufficiency. The patients were separated into two groups on the basis of age (group I: ≥60 years and group II: <60 years). Outcomes of patients in terms of the requirement of renal replacement therapy and mortality were recorded. RESULTS In patients with group I, the causes of AA amyloidosis were as follows: FMF 16 (50%), bronchiectasis 7 (23%), chronic osteomyelitis 2 (6%), inflammatory bowel disease 2 (6%), rheumatoid arthritis 2 (6%), ankylosing spondylitis 1 (3%) and unknown aetiology 2 (6%). The underlying disorders of AA amyloidosis in group II patients were as follows: FMF 17 (81%), Behcet's disease 1 (5%) and unknown aetiology 3 (14%). No statistically significant differences were detected between two groups with regard to systolic and diastolic blood pressures, albumin, proteinuria and lipids. The combination of chronic kidney disease and nephrotic syndrome was the most common clinical presentation in group I (73%) and group II (43%) (p = .05). Compared to the group II, estimated glomerular filtration rate was significantly lower in group I at the time of kidney biopsy (p = .003). At 12-month follow-up, 61% of the group I and 33% of the group II developed end-stage kidney disease requiring dialysis, while 11% of the group I died. CONCLUSION Our results indicated that renal AA amyloidosis is a rare disease in advanced age patients. At baseline and follow-up period, advanced age patients had worse kidney disease and outcomes.
Collapse
Affiliation(s)
- Siyar Erdogmus
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Zeynep Kendi Celebi
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Serkan Akturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Gizem Kumru
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Neval Duman
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Ates
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sehsuvar Erturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Gokhan Nergizoglu
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sim Kutlay
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sule Sengul
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Keven
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| |
Collapse
|
17
|
Karim AF, Eurelings LEM, van Hagen PM, van Laar JAM. Implications of elevated C-reactive protein and serum amyloid A levels in IgG4-related disease: comment on the article by Perugino et al. Arthritis Rheumatol 2018; 70:317-318. [PMID: 29088583 DOI: 10.1002/art.40365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A Faiz Karim
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
18
|
Ayar Y, Ersoy A, Oksuz MF, Ocakoglu G, Vuruskan BA, Yildiz A, Isiktas E, Oruc A, Celikci S, Arslan I, Sahin AB, Güllülü M. Desfechos clínicos e sobrevida em pacientes com amiloidose AA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
Ayar Y, Ersoy A, Oksuz MF, Ocakoglu G, Vuruskan BA, Yildiz A, Isiktas E, Oruc A, Celikci S, Arslan I, Sahin AB, Güllülü M. Clinical outcomes and survival in AA amyloidosis patients. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:535-544. [PMID: 29173691 DOI: 10.1016/j.rbre.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis. METHODS A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results. RESULTS Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months. CONCLUSION Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis.
Collapse
Affiliation(s)
- Yavuz Ayar
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey.
| | - Alparslan Ersoy
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | | | - Gokhan Ocakoglu
- Uludağ University Medical Faculty, Department of Biostatistics, Bursa, Turkey
| | | | - Abdülmecit Yildiz
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Emel Isiktas
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Aysegül Oruc
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| | - Sedat Celikci
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Ismail Arslan
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Ahmet Bilgehan Sahin
- Uludağ University Medical Faculty, Department of Internal Medicine, Bursa, Turkey
| | - Mustafa Güllülü
- Uludağ University Faculty of Medicine, Department of Nephrology, Bursa, Turkey
| |
Collapse
|
20
|
Abstract
CONTEXT -Amyloidosis is a heterogeneous group of diseases characterized by the deposition of congophilic amyloid fibrils in the extracellular matrix of tissues and organs. To date, 31 fibril proteins have been identified in humans, and it is now recommended that amyloidoses be named after these fibril proteins. Based on this classification scheme, the most common forms of amyloidosis include systemic AL (formerly primary), systemic AA (formerly secondary), systemic wild-type ATTR (formerly age-related or senile systemic), and systemic hereditary ATTR amyloidosis (formerly familial amyloid polyneuropathy). Three different clinicopathologic forms of amyloidosis can be seen in the lungs: diffuse alveolar-septal amyloidosis, nodular pulmonary amyloidosis, and tracheobronchial amyloidosis. OBJECTIVE -To clarify the relationship between the fibril protein-based amyloidosis classification system and the clinicopathologic forms of pulmonary amyloidosis and to provide a useful guide for diagnosing these entities for the practicing pathologist. DATA SOURCES -This is a narrative review based on PubMed searches and the authors' own experiences. CONCLUSIONS -Diffuse alveolar-septal amyloidosis is usually caused by systemic AL amyloidosis, whereas nodular pulmonary amyloidosis and tracheobronchial amyloidosis usually represent localized AL amyloidosis. However, these generalized scenarios cannot always be applied to individual cases. Because the treatment options for amyloidosis are dependent on the fibril protein-based classifications and whether the process is systemic or localized, the workup of new clinically relevant cases should include amyloid subtyping (preferably with mass spectrometry-based proteomic analysis) and further clinical investigation.
Collapse
|
21
|
Affiliation(s)
- Faiz Karim
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | |
Collapse
|
22
|
Gaspar BL, Garg C, Vasishta RK, Nada R, Goyal MK. Localised SAA amyloidosis with intra-axonal intra-myelin amyloid deposits. Pathology 2016; 49:103-105. [PMID: 27913045 DOI: 10.1016/j.pathol.2016.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/16/2016] [Accepted: 08/24/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - Manoj Kumar Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
23
|
Sahutoglu T, Atay K, Caliskan Y, Kara E, Yazici H, Turkmen A. Comparative Analysis of Outcomes of Kidney Transplantation in Patients With AA Amyloidosis and Chronic Glomerulonephritis. Transplant Proc 2016; 48:2011-6. [DOI: 10.1016/j.transproceed.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/07/2016] [Accepted: 04/27/2016] [Indexed: 01/24/2023]
|
24
|
Imaging mass spectrometry analysis of renal amyloidosis biopsies reveals protein co-localization with amyloid deposits. Anal Bioanal Chem 2015; 407:5323-31. [PMID: 25935672 DOI: 10.1007/s00216-015-8689-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 12/31/2022]
Abstract
Amyloidosis is a heterogeneous group of protein misfolding diseases characterized by deposition of amyloid proteins. The kidney is frequently affected, especially by immunoglobulin light chain (AL) and serum amyloid A (SAA) amyloidosis as the most common subgroups. Current diagnosis relies on histopathological examination, Congo red staining, or electron microscopy. Subtyping is done by immunohistochemistry; however, commercially available antibodies lack specificity. The purpose of this study was to identify and map amyloid proteins in formalin-fixed paraffin-embedded tissue sections using matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis in an integrated workflow. Renal amyloidosis and non-amyloidosis biopsies were processed for histological and MS analysis. Mass spectra corresponding to the congophilic areas were directly linked to the histological and MS images for correlation studies. Peptides for SAA and AL were detected by MALDI IMS associated to Congo red-positive areas. Sequence determination of amyloid peptides by LC-MS/MS analysis provided protein distribution and identification. Serum amyloid P component, apolipoprotein E, and vitronectin proteins were identified in both AA and AL amyloidosis, showing a strong correlation with Congo red-positive regions. Our findings highlight the utility of MALDI IMS as a new method to type amyloidosis in histopathological routine material and characterize amyloid-associated proteins that may provide insights into the pathogenetic process of amyloid formation.
Collapse
|
25
|
Yilmaz S, Cinar M, Simsek I, Erdem H, Pay S. Tocilizumab in the treatment of patients with AA amyloidosis secondary to familial Mediterranean fever. Rheumatology (Oxford) 2014; 54:564-5. [PMID: 25504961 DOI: 10.1093/rheumatology/keu474] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sedat Yilmaz
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey.
| | - Muhammet Cinar
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Ismail Simsek
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Hakan Erdem
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| | - Salih Pay
- Division of Rheumatology, Gulhane School of Medicine, Ankara, Turkey
| |
Collapse
|
26
|
Yılmaz S, Özçakar ZB, Bulum B, Kiremitçi S, Ensari A, Ekim M, Keven K, Yalçınkaya F. De novo amyloidosis in a renal transplant patient. Pediatr Transplant 2014; 18:E259-61. [PMID: 25174445 DOI: 10.1111/petr.12344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/27/2022]
Abstract
Systemic AA amyloidosis is a serious complication of many chronic inflammatory disorders and chronic infections. Renal involvement is seen in the majority of the patients and can lead to end-stage renal disease. Renal transplantation can be performed in these patients; however, amyloidosis can recur in the transplanted kidneys. On the other hand, de novo AA amyloidosis in renal transplant patients has been rarely reported. We report a 17-yr-old patient with end-stage renal disease due to genitourinary anomalies who developed recurrent pyelonephritis after transplantation. Three yr after transplantation, renal biopsy was performed for proteinuria and AA amyloidosis was identified in the renal allograft. Although rare, chronic infections might cause de novo amyloidosis in renal transplant patients. Therefore, amyloidosis should be kept in mind in those types of patients who present with proteinuria.
Collapse
Affiliation(s)
- Songül Yılmaz
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Westermark GT, Fändrich M, Westermark P. AA amyloidosis: pathogenesis and targeted therapy. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2014; 10:321-44. [PMID: 25387054 DOI: 10.1146/annurev-pathol-020712-163913] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The understanding of why and how proteins misfold and aggregate into amyloid fibrils has increased considerably during recent years. Central to amyloid formation is an increase in the frequency of the β-sheet structure, leading to hydrogen bonding between misfolded monomers and creating a fibril that is comparably resistant to degradation. Generation of amyloid fibrils is nucleation dependent, and once formed, fibrils recruit and catalyze the conversion of native molecules. In AA amyloidosis, the expression of cytokines, particularly interleukin 6, leads to overproduction of serum amyloid A (SAA) by the liver. A chronically high plasma concentration of SAA results in the aggregation of amyloid into cross-β-sheet fibrillar deposits by mechanisms not fully understood. Therefore, AA amyloidosis can be thought of as a consequence of long-standing inflammatory disease. This review summarizes current knowledge about AA amyloidosis. The systemic amyloidoses have been regarded as intractable conditions, but improvements in the understanding of fibril composition and pathogenesis over the past decade have led to the development of a number of different therapeutic approaches with promising results.
Collapse
|
28
|
Abstract
Renal involvement is a common occurrence in subjects with rheumatological diseases and can develop either due to the disease itself or secondary to drugs used in the treatment. The prevalence of renal involvement and its severity depends on the underlying disease as well as aggressiveness of the therapy. For most rheumatological diseases, renal involvement heralds a poor prognosis and warrants aggressive immunosuppressive treatment. Thus, it is important to diagnose and manage them at an early stage. On the other hand, patients with primary kidney disease can also develop rheumatological manifestations which need to be differentiated from the former. This article provides the nephrologist's perspective upon various rheumatological disorders and associated renal involvement with the aim of sensitizing the rheumatological community about them, resulting in better management of these subjects.
Collapse
Affiliation(s)
- Tarun Mittal
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | |
Collapse
|
29
|
Renal transplantation in secondary amyloidosis associated with tuberculosis. Case Rep Transplant 2013; 2013:353529. [PMID: 24455394 PMCID: PMC3886239 DOI: 10.1155/2013/353529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/08/2013] [Indexed: 12/03/2022] Open
Abstract
Although end-stage renal disease (ESRD) related to AA amyloidosis nephropathy secondary to tuberculosis is most common in our country, there are limited data concerning patient and graft outcome after renal transplantation (RTx). To the best of our knowledge, this is the first report of RTx in ESRD patient with secondary amyloidosis due to tuberculosis from India. A 30-year-old female with past history of pulmonary tuberculosis 3 years back was admitted with complaint of gradually progressive pedal oedema and nausea for 3 months. Renal biopsy was suggestive of secondary renal amyloidosis with vascular involvement and chronic tubulointerstitial involvement. She was transplanted with kidney from her 28-year-old brother with 3/6 human leukocyte antigen match. She had immediate good graft function without any perioperative complications (cardiovascular, infections, rejection and delayed graft function). She was discharged with serum creatinine of 0.8 mg/dL. Her last serum creatinine level was 0.9 mg/dL with cyclosporine level of 100 mg/dL at 9-month followup without any medical or surgical complication. The quality of life also improved after transplantation. With careful selection, ESRD patients with secondary amyloidosis due to tuberculosis are eligible for RTx with favorable outcome and improved quality of life.
Collapse
|
30
|
|
31
|
Mohty D, Damy T, Cosnay P, Echahidi N, Casset-Senon D, Virot P, Jaccard A. Cardiac amyloidosis: updates in diagnosis and management. Arch Cardiovasc Dis 2013; 106:528-40. [PMID: 24070600 DOI: 10.1016/j.acvd.2013.06.051] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 12/15/2022]
Abstract
Amyloidosis is a severe systemic disease. Cardiac involvement may occur in the three main types of amyloidosis (acquired monoclonal light-chain, hereditary transthyretin and senile amyloidosis) and has a major impact on prognosis. Imaging the heart to characterize and detect early cardiac involvement is one of the major aims in the assessment of this disease. Electrocardiography and transthoracic echocardiography are important diagnostic and prognostic tools in patients with cardiac involvement. Cardiac magnetic resonance imaging better characterizes myocardial involvement, functional abnormalities and amyloid deposition due to its high spatial resolution. Nuclear imaging has a role in the diagnosis of transthyretin amyloid cardiomyopathy. Cardiac biomarkers are now used for risk stratification and staging of patients with light-chain systemic amyloidosis. Different types of cardiac complications may occur, including diastolic followed by systolic heart failure, atrial and/or ventricular arrhythmias, conduction disturbances, embolic events and sometimes sudden death. Senile amyloid and hereditary transthyretin amyloid cardiomyopathy have better prognoses than light-chain amyloidosis. Cardiac treatment of heart failure is usually ineffective and is often poorly tolerated because of its hypotensive and bradycardiac effects. The three main types of amyloid disease, despite their similar cardiac appearance, have specific new aetiological treatments that may change the prognosis of this disease. Cardiologists should be aware of this disease to allow early treatment.
Collapse
Affiliation(s)
- Dania Mohty
- Service de cardiologie, pôle cœur-poumon-rein, hôpital Dupuytren, CHU de Limoges, 87042 Limoges, France; Service d'hématologie clinique et de thérapie cellulaire, pôle onco-hématologie, centre national de référence pour l'amylose AL et autres maladies de dépôts d'immunoglobulines monoclonales, CHU de Limoges, Limoges, France.
| | | | | | | | | | | | | |
Collapse
|
32
|
Sakallı H, Kal Ö. Mean platelet volume as a potential predictor of proteinuria and amyloidosis in familial Mediterranean fever. Clin Rheumatol 2013; 32:1185-90. [DOI: 10.1007/s10067-013-2257-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/06/2013] [Accepted: 04/01/2013] [Indexed: 11/25/2022]
|