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Mazzucchelli R, Almodovar-González R, Dieguez-Costa E, Crespí-Villarías N, Pérez-Fernández E, García-Zamora E, Garcia Vadillo A. Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015)-TREND-EspA study. RMD Open 2021; 7:rmdopen-2021-001782. [PMID: 34593628 PMCID: PMC8487213 DOI: 10.1136/rmdopen-2021-001782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/14/2021] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years). Methods An observational retrospective population-based matched cohort study was conducted. All the admissions of patients with SpA, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease (SpA-IBD) and reactive arthritis (ReA), reported between 1999 and 2015, were analysed and a control group matched by age, sex and year of admission was selected. Incidence rates for amyloidosis were calculated. Generalised linear models were used for trend analysis and unconditional logistic regression for calculating crude and adjusted ORs (AOR) to assess the association between amyloidosis and SpA. Results The study database contained data on 107 140 admissions in each group. Between 1999 and 2015, 792 patients in the SpA cohort (0.7% of all admissions) had a diagnosis of amyloidosis versus 68 in the non-SpA cohort (0.1%) (p<0.001). From 1999 to 2015, incidence rates of amyloidosis tended to decrease in the SpA cohort (−4.63%/year overall), while they increased in the Non-SpA cohort (+10.25%/year overall). We found strong associations of amyloidosis with all SpAs (AOR 10.4; 95% CI 8.2 to 13.3) and with each type studied (AORs 10.05 (7.84 to 12. 88) for AS, 9.5 (7.3 to 12.4) for PsA, 22.9 (16.6 to 31.7) for SpA-IBD and 10.1 (6.1 to 16.7) for ReA). Conclusions Incidence of amyloidosis among patients with SpA has strongly decreased in Spain. Amyloidosis is most strongly associated with SpA-IBD while the strength of association with PsA and ReA is similar to that with AS.
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Affiliation(s)
- Ramon Mazzucchelli
- Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain .,Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Raquel Almodovar-González
- Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.,Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Elisa Dieguez-Costa
- Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América, Madrid, Spain
| | | | | | - Elena García-Zamora
- Dermatology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
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Garo F, Chatelain J, Aglae C, Moranne O. Two cases of secondary AA amyloidosis involving the skin and chronic kidney infection with a nephrotic syndrome in a high-income country. BMJ Case Rep 2021; 14:14/6/e239411. [PMID: 34099444 DOI: 10.1136/bcr-2020-239411] [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: 11/04/2022] Open
Abstract
We present two French cases of amyloid-associated (AA) amyloidosis secondary to chronic infections. Patient 1, a 51-year-old heroin addict, was hospitalised for chest pain and anasarca. During hospitalisation, a nephrotic syndrome with an inflammatory condition was discovered along with a chronic skin ulcer on his arm. Salivary gland and kidney biopsies confirmed the diagnosis of AA amyloidosis. Renal function quickly declined and haemodialysis was initiated 6 months later. Patient 2, a 55-year-old woman, was hospitalised for obstructive pyelonephritis secondary to coraliform lithiasis. Renal insufficiency with an impure nephrotic syndrome was found. After nephrectomy due to chronic pyelonephritis and an atrophic cortex on the abdominal scan, the histology revealed AA amyloidosis. Despite treatment with ACE inhibitors and control of inflammation, the nephrotic syndrome persisted with rapid decline of the kidney function.
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Affiliation(s)
- Florian Garo
- Nephrology Dialysis Apheresis, Hopital Universitaire de Nimes, CHU Caremeau, Nimes, France
| | - Juliette Chatelain
- Nephrology Dialysis Apheresis, Hopital Universitaire de Nimes, CHU Caremeau, Nimes, France
| | - Cedric Aglae
- Nephrology Dialysis Apheresis, Hopital Universitaire de Nimes, CHU Caremeau, Nimes, France.,Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Olivier Moranne
- Nephrology Dialysis Apheresis, Hopital Universitaire de Nimes, CHU Caremeau, Nimes, France .,Faculty of Medicine, University of Montpellier, Montpellier, France
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Eriksson P, Mölne J, Wirestam L, Sjöwall C. Successful Treatment of AA Amyloidosis in Ankylosing Spondylitis Using Tocilizumab: Report of Two Cases and Review of the Literature. Front Med (Lausanne) 2021; 8:661101. [PMID: 33981717 PMCID: PMC8107218 DOI: 10.3389/fmed.2021.661101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/01/2021] [Indexed: 12/02/2022] Open
Abstract
Historically, secondary amyloidosis has been a feared complication of chronic inflammatory conditions. The fibril protein AA derives from the acute phase reactant serum amyloid A (SAA). Long-term elevation of SAA levels remains a major risk factor for the development of AA amyloidosis in rheumatic diseases, and the prognosis may be unpredictable. Nowadays, with increased availability of effective biological agents, the incidence of AA amyloidosis seems to be declining. Still, genetically predisposed subjects with slowly progressive disease and mild symptoms combined with ongoing systemic inflammation may be at risk. Interleukin-6 (IL-6) is one of the drivers of SAA release and effectiveness of the humanized anti-IL-6 receptor antibody tocilizumab (TCZ) for the treatment of AA amyloidosis has been observed in some rheumatic conditions. Herein, we report two male subjects with longstanding ankylosing spondylitis (AS) complicated by renal amyloidosis who received TCZ with rapid and beneficial effects regarding inflammation and proteinuria. To the best of our knowledge, the use of TCZ in AS patients with this extra-articular manifestation has not previously been described. The paper includes histopathology, clinical follow-up, and longitudinal data of the two cases along with a comprehensive review of relevant literature. Mechanisms behind amyloid-mediated tissue damage and organ dysfunction are discussed. Altogether, our data highlight that blocking IL-6 signaling may represent a promising therapeutic option in patients with renal AA amyloidosis.
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Affiliation(s)
- Per Eriksson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Johan Mölne
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lina Wirestam
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
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4
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Kalle A, Gudipati A, Raju SB, Kalidindi K, Guditi S, Taduri G, Uppin MS. Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience. J Lab Physicians 2020; 10:226-231. [PMID: 29692592 PMCID: PMC5896193 DOI: 10.4103/jlp.jlp_148_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION: Kidney involvement is a major cause of mortality in systemic amyloidosis. Glomerulus is the most common site of deposition in renal amyloidosis, and nephrotic syndrome is the most common presentation. Distinction between AA and AL is done using immunofluorescence (IF) and immunohistochemistry (IHC). Renal biopsy helps in diagnosis and also predicting the clinical course by applying scoring and grading to the biopsy findings. MATERIALS AND METHODS: The study includes all cases of biopsy-proven renal amyloidosis from January 2008 to May 2017. Light microscopic analysis; Congo red with polarization; IF; IHC for Amyloid A, kappa, and lambda; and bone marrow evaluation were done. Classification of glomerular amyloid deposition and scoring and grading are done as per the guidelines of Sen S et al. RESULTS: There are 40 cases of biopsy-proven renal amyloidosis with 12 primary and 23 secondary cases. Mean age at presentation was 42.5 years. Edema was the most common presenting feature. Secondary amyloidosis cases were predominant. Tuberculosis was the most common secondary cause. Multiple myeloma was detected in four primary cases. Grading of renal biopsy features showed a good correlation with the class of glomerular involvement. CONCLUSION: Clinical history, IF, and IHC are essential in amyloid typing. Grading helps provide a subtle guide regarding the severity of disease in the background of a wide range of morphological features and biochemical values. Typing of amyloid is also essential for choosing the appropriate treatment.
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Affiliation(s)
- Abhiram Kalle
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Archana Gudipati
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Karthik Kalidindi
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Swarnalatha Guditi
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gangadhar Taduri
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Di Giovanni B, Gustafson D, Adamson MB, Delgado DH. Hiding in Plain Sight: Cardiac Amyloidosis, an Emerging Epidemic. Can J Cardiol 2019; 36:373-383. [PMID: 32145865 DOI: 10.1016/j.cjca.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
Amyloidosis is a term used to describe a group of rare heterogeneous diseases that ultimately result in the deposition and accumulation of misfolded proteins. These misfolded proteins, known as amyloids, are associated with a variety of precursor proteins that have amyloidogenic potential. Ultimately, the specific type of amyloidosis is dependent on multiple factors including genetic variability of precursor proteins and the tissue or organ in which the amyloid accumulates. Several types of amyloid have a predilection for the heart and thus contribute to cardiac amyloidosis, a major cause of restrictive cardiomyopathy. Individuals with cardiac amyloidosis present clinically with heart failure with preserved ejection fraction. Although improved diagnostics and increased awareness of cardiac amyloidosis have led to a relative increase in diagnosis, cardiac amyloidosis remains an underrecognized and underdiagnosed cause of heart failure with preserved ejection fraction. It is essential to properly identify cases of cardiac amyloidosis and determine the pathology responsible for the formation of amyloid to appropriately provide management. This review aims to encourage physician awareness of cardiac amyloidosis by focusing on clinical presentation and the distinctions between types. Furthermore, epidemiology is central to understanding the affected demographics and sometimes hereditary nature of the disease. Improved understanding of cardiac amyloidosis will ideally lead to earlier diagnosis and interventions to improve patient outcomes.
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Affiliation(s)
- Bennett Di Giovanni
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Dakota Gustafson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mitchell B Adamson
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Diego H Delgado
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Hassen M, Bates W, Moosa MR. Pattern of renal amyloidosis in South Africa. BMC Nephrol 2019; 20:406. [PMID: 31706285 PMCID: PMC6842472 DOI: 10.1186/s12882-019-1601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background Kidney disease is a serious manifestation of systemic amyloidosis and a major cause of morbidity and mortality. Tuberculosis (TB) occurs up to 27 times more commonly in human immunodeficiency virus (HIV) infected patients and is also an important cause of renal amyloid; there are however no reports of renal amyloidosis in South Africa in the HIV era. Methods This was a retrospective record review of cases of amyloidosis diagnosed on renal biopsies at our tertiary referral hospital between January 1985 and December 2016. Results Forty-six cases of amyloidosis were identified over the study period. The calculated biopsy prevalence was 1.38 per 100 non-transplant renal biopsies (95% Confidence Interval 1.02–1.86). AL amyloidosis was identified in 26 (57%) cases and AA in 20 (43%). The median age at presentation was 51 years and 52% of cases were female. Patients with AA amyloidosis were significantly younger compared to their AL counterparts (age 42 years vs. 58 years, p = < 0.001) and were all significantly non-white. The main clinical presentation was nephrotic syndrome (85%) and 52% of cases also had a serum creatinine value of greater than 120 μmol/L. Of the 20 cases of AA amyloidosis, 12 (60%) were associated with tuberculosis. HIV infection was noted in only two (10%) of the 20 AA cases. Median survival after diagnosis was 2 months. Conclusion Amyloidosis is a rare cause of kidney disease and typically presents with nephrotic syndrome. A similar number of AA and AL types were observed, and outcomes are worse in cases of AA amyloid. While TB remains the major underlying disease in this type, HIV infection was infrequent in cases of AA renal amyloidosis.
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Affiliation(s)
- Muhammed Hassen
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - William Bates
- Department of Anatomical Pathology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mohammed Rafique Moosa
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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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]
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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
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9
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Esatoglu SN, Hatemi G, Ugurlu S, Gokturk A, Tascilar K, Ozdogan H. Long-term follow-up of secondary amyloidosis patients treated with tumor necrosis factor inhibitor therapy: A STROBE-compliant observational study. Medicine (Baltimore) 2017; 96:e7859. [PMID: 28834898 PMCID: PMC5572020 DOI: 10.1097/md.0000000000007859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
There are no treatment modalities, which were proven to prevent the deposition of amyloid, proteinuria, and loss of renal function due to amyloidosis. Anti-tumor necrosis factor agents (anti-TNFs) were shown to decrease the production of serum amyloid A protein.We aimed to evaluate the long-term efficacy and safety of anti-TNFs in secondary (AA) amyloidosis patients treated in a single center.Thirty-seven patients with AA amyloidosis were started an anti-TNF for AA amyloidosis between March 2001 and June 2008 and followed until May 2016 unless deceased. They were surveyed for the endpoints of death, development of end-stage renal disease (ESRD), switch to another agent due to worsening of amyloidosis and adverse events.Among the 37 patients, 12 (32%) had died, 9 (24%) had ESRD, and 8 (22%) had started another group of biologic due to worsening of amyloidosis indicated by an increase in proteinuria, 5 (14%) patients are still doing well with anti-TNFs, and 3 (8%) are off treatment at the end of a median follow-up of 10 (interquartile range [IQR]: 5.5-10.5) years since the start of anti-TNFs and 10 (IQR: 8-13) years since the diagnosis of AA amyloidosis. Most common serious adverse events were sepsis and thrombotic events observed in 8 and 4 patients, respectively.Treatment with anti-TNFs may be associated with a higher survival rate compared with historic cohorts of AA amyloidosis, especially when started early with a lower serum creatinine level at baseline. Caution is needed regarding serious adverse events, especially infections.
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Affiliation(s)
- Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University
| | - Aycan Gokturk
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Koray Tascilar
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University
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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.
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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
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Jijón Crespín R, Ortiz Sánchez ML, Vargas Acosta A, Antonio Pons J, Navarro Noguera E, Estrella Diez E, Sánchez Velasco E, Carrilero Zaragoza G, Pereñíguez López A, Muñoz M, Antón G, Fernando Carballo L. [Portal hypertension and cholestatic jaundice as a form of presentation of systemic amyloidosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:22-23. [PMID: 25958123 DOI: 10.1016/j.gastrohep.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | | | - Angel Vargas Acosta
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | - Jose Antonio Pons
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | | | | | | | | | | | - María Muñoz
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | - Gonzalo Antón
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
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Cadiñanos J, Costa R, Trujillo D, Real de Asúa D. Amiloidosis sistémica secundaria AA. Med Clin (Barc) 2015; 144:324-30. [DOI: 10.1016/j.medcli.2014.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
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Real de Asúa D, Costa R, Galván JM, Filigheddu MT, Trujillo D, Cadiñanos J. Systemic AA amyloidosis: epidemiology, diagnosis, and management. Clin Epidemiol 2014; 6:369-77. [PMID: 25378951 PMCID: PMC4218891 DOI: 10.2147/clep.s39981] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The term “amyloidosis” encompasses the heterogeneous group of diseases caused by the extracellular deposition of autologous fibrillar proteins. The global incidence of amyloidosis is estimated at five to nine cases per million patient-years. While amyloid light-chain (AL) amyloidosis is more frequent in developed countries, amyloid A (AA) amyloidosis is more common in some European regions and in developing countries. The spectrum of AA amyloidosis has changed in recent decades owing to: an increase in the median age at diagnosis; a percent increase in the frequency of primary AL amyloidosis with respect to the AA type; and a substantial change in the epidemiology of the underlying diseases. Diagnosis of amyloidosis is based on clinical organ involvement and histological evidence of amyloid deposits. Among the many tinctorial characteristics of amyloid deposits, avidity for Congo red and metachromatic birefringence under unidirectional polarized light remain the gold standard. Once the initial diagnosis has been made, the amyloid subtype must be identified and systemic organ involvement evaluated. In this sense, the 123I-labeled serum amyloid P component scintigraphy is a safe and noninvasive technique that has revolutionized the diagnosis and monitoring of treatment in systemic amyloidosis. It can successfully identify anatomical patterns of amyloid deposition throughout the body and enables not only an initial estimation of prognosis, but also the monitoring of the course of the disease and the response to treatment. Given the etiologic diversity of AA amyloidosis, common therapeutic strategies are scarce. All treatment options should be based upon a greater control of the underlying disease, adequate organ support, and treatment of symptoms. Nevertheless, novel therapeutic strategies targeting the formation of amyloid fibrils and amyloid deposition may generate new expectations for patients with AA amyloidosis.
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Affiliation(s)
- Diego Real de Asúa
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ramón Costa
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Jose María Galván
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - María Teresa Filigheddu
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Davinia Trujillo
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Julen Cadiñanos
- Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
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Minimally invasive minor salivary gland biopsy for the diagnosis of amyloidosis in a rheumatology clinic. ISRN RHEUMATOLOGY 2014; 2014:354648. [PMID: 24707407 PMCID: PMC3953425 DOI: 10.1155/2014/354648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022]
Abstract
Background. Systemic amyloidosis is a potentially fatal condition, unless diagnosed and treated before development of irreversible organ damage.
Demonstration of amyloid deposits within tissue biopsies is only definitive diagnostic method, which makes appropriate selection of biopsy site essential. Herein,
we evaluated efficacy of minimally invasive minor salivary gland biopsy (MSGB) for the diagnosis of amyloidosis. Methods. We analyzed 37 biopsies taken from
35 patients. Suggestive findings for amyloidosis were significant proteinuria, renal impairment, refractory diarrhea, neuropathy, and restrictive cardiomyopathy.
Minor salivary gland was the initial biopsy site in all subjects. When MSGB was negative but there was a high suspicion for amyloidosis, a kidney, duodenum,
or rectal biopsy was performed for further investigation. Results. Mean age of patients was 45.4 and 21 were female. In 11 patients amyloidosis was diagnosed
with MSGB. In overall 18 patients were diagnosed with amyloidosis. Sixteen of them were identified as being of AA type and two were AL type amyloidosis.
The sensitivity of minimally invasive MSGB is 61.1% for diagnosing amyloidosis in this study. Conclusion. MSGB is a safe and simple method for the diagnosis
of amyloidosis which can be performed in an outpatient setting. We suggest extensive use of this minimally invasive method.
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