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Ozdemir A, Yılmaz M, Ozagari AA, Kocak SY. Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis. Int Urol Nephrol 2022; 54:2591-2597. [PMID: 35275358 DOI: 10.1007/s11255-022-03163-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The amount and distribution pattern of amyloid deposits may contribute to renal function and outcome, given the great diversity of renal involvement in amyloidosis. The aim of this study was to analyze the impact of histological characteristics of patients with biopsy-proven renal AA amyloidosis (AAA) on renal outcome. METHODS Renal biopsies of 37 patients with AAA were re-evaluated. The distribution pattern of glomerular amyloid (GA) deposits was classified, the extent of amyloid deposits in glomeruli, vessel, and interstitium and other histopathologic lesions were scored, and renal amyloid prognostic score (RAPS) was determined by summing all scores. Their potential prognostic relevance on renal outcome was investigated. RESULTS GA and vascular amyloid (VA) deposits were noted in all cases, interstitial amyloid (IA) was detected in 70.2%. GA deposits were predominantly seen in diffuse mesengiocapillary fashions (class IV) (51.4%). GA class, the extent of GA, VA, IA deposit, and RAPS, as well as interstitial fibrosis (IF) and interstitial inflammation were correlated to renal function at diagnosis. During the median follow-up of 52 months, 13 patients developed doubling of serum creatinine or end stage renal disease and they had a higher degree of GA and VA load (p = 0.03 and p = 0.042, respectively) as compared to the remaining patients. VA load, but not GA and RAPS grade, was associated with poor renal outcome (HR 3.016, 95% CI 1.45-6.25, p = 0.003). CONCLUSIONS Baseline renal function is closely linked to the extent of AA amyloid deposit in renal parenchyma but only VA load was a predictor of renal outcome in AAA patients.
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Affiliation(s)
- Arzu Ozdemir
- Department of Nephrology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, 34147, Bakirkoy, Istanbul, Turkey.
| | - Mürvet Yılmaz
- Department of Nephrology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, 34147, Bakirkoy, Istanbul, Turkey
| | - Ayse Aysim Ozagari
- Department of Pathology, Sisli Hamdiye Etfal Education and Research Hospital, Halaskargazi Cd., 34371, Sisli, Istanbul, Turkey
| | - Sibel Yucel Kocak
- Department of Nephrology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, 34147, Bakirkoy, Istanbul, Turkey
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Meng S, Xia W, Xia L, Zhou L, Xu J, Pan X, Meng L. A Pilot Study of Rare Renal Amyloidosis Based on FFPE Proteomics. Molecules 2021; 26:molecules26237234. [PMID: 34885818 PMCID: PMC8659071 DOI: 10.3390/molecules26237234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Abstract
Renal amyloidosis typically manifests albuminuria, nephrotic-range proteinuria, and ultimately progresses to end-stage renal failure if diagnosed late. Different types of renal amyloidosis have completely different treatments and outcomes. Therefore, amyloidosis typing is essential for disease prognosis, genetic counseling and treatment. Thirty-six distinct proteins currently known to cause amyloidosis that have been described as amyloidogenic precursors, immunohistochemistry (IHC) or immunofluorescence (IF), can be challenging for amyloidosis typing especially in rare or hereditary amyloidosis in clinical practice. We made a pilot study that optimized the proteomics pre-processing procedures for trace renal amyloidosis formalin-fixed paraffin-embedded (FFPE) tissue samples, combined with statistical and bioinformatics analysis to screen out the amyloidosis-related proteins to accurately type or subtype renal amyloidosis in order to achieve individual treatment. A sensitive, specific and reliable FFPE-based proteomics analysis for trace sample manipulation was developed for amyloidosis typing. Our results not only underlined the great promise of traditional proteomics and bioinformatics analysis using FFPE tissues for amyloidosis typing, but also proved that retrospective diagnosis and analysis of previous cases laid a solid foundation for personalized treatment.
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Affiliation(s)
- Shuang Meng
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Wenwen Xia
- Department of Pathology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
| | - Li Xia
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Li Zhou
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
| | - Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
- Correspondence: (X.P.); (L.M.); Tel.: +86-21-64370045 (X.P.); +86-21-63846590 (L.M.)
| | - Liyuan Meng
- Department of Core Facility of Basic Medical Sciences, Shanghai Jiao Tong University School of Basic Medicine, Shanghai 200025, China; (S.M.); (L.X.); (L.Z.)
- Correspondence: (X.P.); (L.M.); Tel.: +86-21-64370045 (X.P.); +86-21-63846590 (L.M.)
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Gupta N, Sahar T, Khowal S, Ganaie IA, Mughees M, Khullar D, Jain SK, Wajid S. Differential levels of CHMP2B, LLPH, and SLC25A51 proteins in secondary renal amyloidosis. Expert Rev Proteomics 2021; 18:65-73. [PMID: 33583303 DOI: 10.1080/14789450.2021.1890588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Renal amyloidosis (RA) is a rare disease, typically manifested with proteinuria, nephrotic syndrome, and ultimately leads to renal failure. The present study aims to profile the proteomes of renal amyloidosis patient's serum and healthy controls, along with relative quantification to find out robust markers for RA. METHODS In this study, 12 RA patients and their corresponding age and gender-matched healthy controls were recruited from the Nephrology department of Max Super Specialty Hospital, New Delhi. We employed gel-based proteomic approach coupled with MALDI-TOF MS to compare protein expression patterns in RA patients and controls. Furthermore, validation of differential proteins (selected) was done using bio-layer interferometry. RESULTS Eleven proteins showed remarkably altered expression levels. Moreover, expression modulation of three proteins (LLPH, SLC25A51, and CHMP2B) was validated which corroborated with two-dimensional gel electrophoresis (2-DE) results showing significant upregulation (p < 0.05) in RA patients followed by ROC analysis which demonstrated the diagnostic potential of these proteins. A protein-protein master network was generated implicating the above identified proteins along with their interactors, fishing out the routes leading to amyloidosis. CONCLUSION This study indicates that the identified serum proteomic signatures could improve early diagnosis and lead to possible therapeutic targets in RA.
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Affiliation(s)
- Nimisha Gupta
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
| | - Tahreem Sahar
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
| | - Sapna Khowal
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
| | - Ishfaq Ahmad Ganaie
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
| | - Mohd Mughees
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
| | - Dinesh Khullar
- Department of Nephrology Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, INDIA
| | - S K Jain
- Department of Biochemistry, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, INDIA
| | - Saima Wajid
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, INDIA
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Adachi M, Kitamura M, Muta K, Maekawa A, Uramatsu T, Tadokoro M, Funakoshi S, Hisano S, Kuwahara N, Shimizu A, Mukae H, Nishino T. IgM monoclonal gammopathy with heavy-and-light-chain amyloidosis resembling fibrillary glomerulonephritis determined by tandem mass spectrometry: a case report. BMC Nephrol 2020; 21:195. [PMID: 32448180 PMCID: PMC7245905 DOI: 10.1186/s12882-020-01851-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/11/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fibrillary glomerulonephritis (FGN) is distinguished from amyloidosis by thicker fibrils and the lack of staining with histochemical dyes typically reactive with amyloid. However, congophilic FGN has been proposed recently and adding laser microdissection followed by mass spectrometry (LMD/MS) to conventional pathological methods would be helpful to diagnose FGN. Here, we report a patient initially diagnosed with FGN whose final pathological diagnosis was changed to immunoglobulin heavy-and-light-chain amyloidosis (AHL) after LMD/MS. CASE PRESENTATION A 75-year-old male developed nephrotic syndrome. Protein electrophoresis showed IgM κ type M proteinemia and he was diagnosed with IgM monoclonal gammopathy. A renal biopsy was performed and pathological examination showed marked periodic acid-Schiff-positive enlargement of the mesangial region and silver stain positivity, but weak direct fast scarlet staining. Immunofluorescence analysis showed monoclonal deposition of IgM-κ chain in the glomerulus. Under electron microscopy, the fibrils were about 20 nm in diameter, which was thicker than typical amyloid fibrils. Based on these findings, the patient was diagnosed with FGN. Although cyclophosphamide and prednisolone were administered, his renal function deteriorated and progressed to end stage renal disease requiring maintenance hemodialysis. As congophilic FGN has been recognized since 2018, Congo red staining and LMD/MS were performed. The Congo red staining was positive and LMD/MS results indicated that this was a case of AHL. CONCLUSIONS We reported a case of μ and κ chain AHL resembling FGN requiring LMD/MS for definitive diagnosis. Since FGN and amyloidosis exhibit pathological findings, even if Congo red staining is positive, LMD/MS needs to be considered in cases atypical pathological findings, such as silver stain positivity or thicker fibrils.
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Affiliation(s)
- Misa Adachi
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. .,Department of Nephrology, Nagasaki Renal Center, Nagasaki, Japan.
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiro Maekawa
- Department of Nephrology, Nagasaki Medical Center, Omura, Japan
| | - Tadashi Uramatsu
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Tadokoro
- Department of Nephrology, Koritsu Shin-Obama Hospital, Nagasaki, Japan
| | | | - Satoshi Hisano
- Department of Pathology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Naomi Kuwahara
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Konstandi M, Sotiropoulos I, Matsubara T, Malliou F, Katsogridaki A, Andriopoulou CE, Gonzalez FJ. Adrenoceptor-stimulated inflammatory response in stress-induced serum amyloid A synthesis. Psychopharmacology (Berl) 2019; 236:1687-1699. [PMID: 30612190 PMCID: PMC6643287 DOI: 10.1007/s00213-018-5149-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE Stressful life events are suggested to contribute to the development of various pathologies, such as cardiovascular disorders, whose etiopathogenesis is highly associated with elevated levels of serum amyloid A (SAA) proteins. SAA synthesis in the liver is regulated by a complex network of cytokines acting independently or in concert with various hormones/stimulants including the stress-activated sympathetic nervous system. OBJECTIVE This study aims to investigate the underlying mechanisms that regulate the stress-induced hepatic synthesis of SAA, with particular focus on adrenoceptors (AR), major components of the sympathoadrenal response to stress. METHODS AND RESULTS We demonstrated that repeated stress elevates IL-1β, IL-6, and TNFα serum levels in mice, accompanied by increased synthesis and secretion of hepatic SAA1/2 and SAA3, an effect that was blocked by AR antagonists. Moreover, stimulation of α1- and β1/2-ARs mimics the stress effect on SAA1/2 regulation, whereas α2-AR stimulation exhibits a relatively weak impact on SAA. In support of the essential cytokine contribution in the AR-agonist induced SAA production is the fact that the anti-inflammatory drug, sodium salicylate, prevented the AR-stimulated hepatic SAA1/2 synthesis by reducing IL-1β levels, whereas IL-1β inhibition with Anakinra mimics this sodium salicylate preventive effect, thus indicating a crucial role for IL-1β. Interestingly, the AR-driven SAA3 synthesis was elevated by sodium salicylate in a TNFα-dependent way, supporting diverse and complex regulatory roles of cytokines in SAA production. In contrast to α1/α2-AR, the β1/2-AR-mediated SAA1/2 and SAA3 upregulation cannot be reversed by fenofibrate, a hypolipidemic drug with anti-inflammatory properties. CONCLUSION Taken together, these findings strongly support a critical role of the AR-stimulated inflammatory response in the hepatic SAA production under stressful conditions, highlighting distinct AR type-specific mechanisms that regulate the hepatic synthesis of SAA1/2 and SAA3.
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Affiliation(s)
- Maria Konstandi
- Faculty of Medicine, Department of Pharmacology, University of Ioannina, Ioannina, Greece. .,Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Ioannis Sotiropoulos
- Life and Health Sciences Research Institute (ICVS), Medical School University of Minho, Braga, Portugal,ICVS/3B’s - PT Government Associate Laboratory, Braga, Portugal
| | - Tsutomu Matsubara
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA,Graduate School of Medicine, Department of Anatomy and Regenerative Biology, Osaka City University, Osaka, Japan
| | - Foteini Malliou
- Faculty of Medicine, Department of Pharmacology, University of Ioannina, Ioannina, Greece
| | - Alexandra Katsogridaki
- Faculty of Medicine, Department of Pharmacology, University of Ioannina, Ioannina, Greece
| | | | - Frank J. Gonzalez
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Kuroda T, Tanabe N, Hasegawa E, Wakamatsu A, Nozawa Y, Sato H, Nakatsue T, Wada Y, Ito Y, Imai N, Ueno M, Nakano M, Narita I. Significant association between renal function and area of amyloid deposition in kidney biopsy specimens in both AA amyloidosis associated with rheumatoid arthritis and AL amyloidosis. Amyloid 2017; 24:123-130. [PMID: 28613962 DOI: 10.1080/13506129.2017.1338565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The kidney is a major target organ for systemic amyloidosis, which results in proteinuria and an elevated serum creatinine level. The clinical manifestations and precursor proteins of amyloid A (AA) and light-chain (AL) amyloidosis are different, and the renal damage due to amyloid deposition also seems to differ. The purpose of this study was to clarify haw the difference in clinical features between AA and AL amyloidosis are explained by the difference in the amount and distribution of amyloid deposition in the renal tissues. A total of 119 patients participated: 58 patients with an established diagnosis of AA amyloidosis (AA group) and 61 with AL amyloidosis (AL group). We retrospectively investigated the correlation between clinical data, pathological manifestations, and the area occupied by amyloid in renal biopsy specimens. In most of the renal specimens the percentage area occupied by amyloid was less than 10%. For statistical analyses, the percentage area of amyloid deposition was transformed to a common logarithmic value (Log10%amyloid). The results of sex-, age-, and Log10%amyloid-adjusted analyses showed that systolic blood pressure (SBP) was higher in the AA group. In terms of renal function parameters, serum creatinine, creatinine clearance (Ccr) and estimated glomerular filtration rate (eGFR) indicated significant renal impairment in the AA group, whereas urinary protein indicated significant renal impairment in the AL group. Pathological examinations revealed amyloid was predominantly deposited at glomerular basement membrane (GBM) and easily transferred to the mesangial area in the AA group, and it was predominantly deposited at in the AL group. The degree of amyloid deposition in the glomerular capillary was significantly more severe in AL group. The frequency of amyloid deposits in extraglomerular mesangium was not significantly different between the two groups, but in AA group, the degree amyloid deposition was significantly more severe, and the deposition pattern in the glomerulus was nodular. Nodular deposition in extraglomerular mesangium leads to renal impairment in AA group. There are significant differences between AA and AL amyloidosis with regard to the renal function, especially in terms of Ccr, eGFR and urinary protein, even after Log10%amyloid was adjusted; showing that these inter-group differences in renal function would not be depend on the amount of renal amyloid deposits. These differences could be explained by the difference in distribution and morphological pattern of amyloid deposition in the renal tissue.
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Affiliation(s)
- Takeshi Kuroda
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Naohito Tanabe
- b Department of Health and Nutrition Faculty of Human Life Studies , University of Niigata Prefecture , Niigata , Japan
| | - Eriko Hasegawa
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Ayako Wakamatsu
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yukiko Nozawa
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Hiroe Sato
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Takeshi Nakatsue
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yoko Wada
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yumi Ito
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Naofumi Imai
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Mitsuhiro Ueno
- c University Health Center , Joetsu University of Education , Niigata , Japan
| | - Masaaki Nakano
- d Department of Medical Technology School of Health Sciences Faculty of Medicine , Niigata University , Niigata , Japan
| | - Ichiei Narita
- a Division of Clinical Nephrology and Rheumatology , Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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8
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A clinical evaluation of renal amyloidosis in the Japan renal biopsy registry: a cross-sectional study. Clin Exp Nephrol 2016; 21:624-632. [PMID: 27562765 DOI: 10.1007/s10157-016-1326-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 08/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The available clinical data are limited in a rare glomerular disease, renal amyloidosis. We aimed to clarify the clinical features of renal amyloidosis from database of the Japan Renal Biopsy Registry (J-RBR). METHODS We performed a cross-sectional study with database of the J-RBR of the Japanese Society of Nephrology. We identified 281 cases of renal amyloidosis from 20,997 cases enrolled into the J-RBR from 2007 to 2014. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were compared among the levels of ages, amount of urine protein excretion (AUPE) or CKD G stages. RESULTS The prevalence of renal amyloidosis was 1.3 % (281/20,997). DBP significantly decreased in higher age quartiles (P = 0.034). SBP and DBP did not increase in the progression of AUPE levels and CKD G stages. In multiple regression analysis, eGFR was a significant independent factor for SBP in all cases and a subgroup without hypertensive agents. There was a reverse significant relationship between SBP and eGFR. CONCLUSION Blood pressure did not significantly increase in elderly and much proteinuric condition in renal amyloidosis. The progression of CKD and decrease of eGFR did not produce the higher SBP. The mechanism underlying these results remains unclear; however, they are unique features of renal amyloidosis. The couple of hypotensive and hypertensive conditions might produce no relationship between blood pressure and CKD stages.
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Ozawa M, Komatsuda A, Ohtani H, Nara M, Sato R, Togashi M, Takahashi N, Wakui H. Long-term prognosis of AL and AA renal amyloidosis: a Japanese single-center experience. Clin Exp Nephrol 2016; 21:212-227. [PMID: 27116248 DOI: 10.1007/s10157-016-1271-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/12/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Few studies have been conducted on the long-term prognosis of patients with amyloid light chain (AL) and amyloid A (AA) renal amyloidosis in the same cohort. METHODS We retrospectively examined 68 patients with biopsy-proven renal amyloidosis (38 AL and 30 AA). Clinicopathological findings at the diagnosis and follow-up data were evaluated in each patient. We analyzed the relationship between clinicopathological parameters and survival data. RESULTS Significant differences were observed in several clinicopathological features, such as proteinuria levels, between the AL and AA groups. Among all patients, 84.2 % of the AL group and 93.3 % of the AA group received treatments for the underlying diseases of amyloidosis. During the follow-up period (median 18 months in AL and 61 months in AA), 36.8 % of the AL group and 36.7 % of the AA group developed end-stage renal failure requiring dialysis, while 71.1 % of the AL group and 56.7 % of the AA group died. Patient and renal survivals were significantly longer in the AA group than in the AL group. eGFR of >60 mL/min/1.73 m2 at biopsy and an early histological stage of glomerular amyloid deposition were identified as low-risk factors. A multivariate analysis showed that cardiac amyloidosis and steroid therapy significantly influenced patient and renal survivals. CONCLUSIONS Our results showed that heart involvement was the major predictor of poor outcomes in renal amyloidosis, and that the prognosis of AA renal amyloidosis was markedly better than that in previously reported cohorts. Therapeutic advances in inflammatory diseases are expected to improve the prognosis of AA amyloidosis.
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Affiliation(s)
- Masatoyo Ozawa
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Nephrology, Akita Red Cross Hospital, Akita, Japan
| | - Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
| | - Hiroshi Ohtani
- Department of Nephrology, Akita Kousei Medical Center, Akita, Japan
| | - Mizuho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Ryuta Sato
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Nephrology, Akita Red Cross Hospital, Akita, Japan
| | - Masaru Togashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Hideki Wakui
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
- Department of Life Science, Akita University Graduate School of Engineering Science, Akita, Japan
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Huang H, Luo Y, Liang Y, Long XD, Peng Y, Liu Z, Wen X, Jia M, Tian R, Bai C, Li C, Dong X. CD4+CD25+ cells in multiple myeloma related renal impairment. Sci Rep 2015; 5:16565. [PMID: 26564056 PMCID: PMC4643310 DOI: 10.1038/srep16565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022] Open
Abstract
CD4+CD25+ cells are critical regulators in almost all of the animal models of human organ-specific autoimmune diseases, transplant rejection and allergic diseases. We aimed to explore the role of CD4+CD25+ cells in the pathogenesis of multiple myeloma (MM) related renal impairment (RI). Thirty patients with MM related RI and 30 healthy volunteers were studied. The number of CD4+CD25+ cells was examined by flow cytometry. Clinical and laboratory data were collected from each subject. Glomerular injury was assessed by histopathology. Serum IL-2, IL-4 and IL-6 were analyzed by ELISA. CD4+CD25+ cells significantly decreased in MM related RI patients compared to the controls (P<0.05). CD4+CD25+ cell number was negatively associated with blood urea nitrogen (BUN), supernatant IL-4, serum IL-6, monoclonal immunoglobulin and β2-microglobulin, as well as bone marrow plasma cell percentage and proteinuria; whereas positively associated with estimated glomerular filtration rate (eGFR) (all P < 0.05). CD4+CD25+ cells gradually decreased as the Clinic Stage increased. The number of CD4+CD25+ cells reduced in MM related RI patients, and was correlated with disease severity. CD4+CD25+ cells may play an important role in the pathogenesis of MM related RI.
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Affiliation(s)
- Hongdong Huang
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China.,Division of Nephrology, Hunan Normal University, Hunan Provincial People's Hospital of China, Changsha, P.R. China
| | - Yang Luo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Yumei Liang
- Division of Nephrology, Hunan Normal University, Hunan Provincial People's Hospital of China, Changsha, P.R. China
| | - Xi-Dai Long
- Department of Liver Surgery, the Affiliated Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Youming Peng
- Hunan Key Laboratory of Nephrology and Hemoperfusion, Division of Nephrology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, P.R. China
| | - Zhihua Liu
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Xiaojun Wen
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Meng Jia
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Ru Tian
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Chengli Bai
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Cui Li
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, P.R. China
| | - Xiaoqun Dong
- Section of Hematology/Oncology, Section of Gastroenterology, Stephenson Cancer Center, Department of Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, USA
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CVID Associated with Systemic Amyloidosis. Case Reports Immunol 2015; 2015:879179. [PMID: 26346511 PMCID: PMC4540992 DOI: 10.1155/2015/879179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/19/2015] [Accepted: 07/22/2015] [Indexed: 12/03/2022] Open
Abstract
Common variable immunodeficiency (CVID) is a frequent primary immune deficiency (PID), which consists of a heterogeneous group of disorders and can present with recurrent infections, chronic diarrhea, autoimmunity, chronic pulmonary and gastrointestinal diseases, and malignancy. Secondary amyloidosis is an uncommon complication of CVID. We report an unusual case of a 27-year-old male patient who presented with recurrent sinopulmonary infections, chronic diarrhea, and hypogammaglobulinemia and was diagnosed with CVID. The patient was treated with intravenous immunoglobulin (IVIg) therapy once every 21 days and daily trimethoprim-sulfamethoxazole for prophylaxis. Two years after initial diagnosis, the patient was found to have progressive decline in IgG levels (as low as 200–300 mg/dL) despite regular Ig infusions. The laboratory tests revealed massive proteinuria and his kidney biopsy showed accumulation of AA type amyloid. We believe that the delay in the diagnosis of CVID and initiation of Ig replacement therapy caused chronic inflammation due to recurrent infections in our patient and this led to an uncommon and life-threatening complication, amyloidosis. Patients with CVID require regular follow-up for the control of infections and assessment of adequacy of Ig replacement therapy. Amyloidosis should be kept in the differential diagnosis when managing patients with CVID.
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12
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Castano E, Palmer MB, Vigneault C, Luciano R, Wong S, Moeckel G. Comparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome. BMC Nephrol 2015; 16:64. [PMID: 25924613 PMCID: PMC4424547 DOI: 10.1186/s12882-015-0046-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/01/2015] [Indexed: 11/30/2022] Open
Abstract
Background Amyloidosis leads to deposition of abnormal protein with beta-pleated sheet structure in specific compartments of the affected organs. The histological localization of these amyloid deposits determines the overall survival of the patient. Methods In this study we have assessed the histological localization and severity of amyloid deposition in 35 patients with biopsy-proven renal amyloidosis and have compared those to clinical parameters, histo-pathological injury criteria and respective patient outcome. Comparisons were statistically analyzed using thus comparison between the different study groups, which was done using Student t-test and analysis of variance. Results We find that the glomerulus is by far the most commonly and most severely affected renal compartment and patients with severe glomerular amyloidosis advance faster towards end stage renal disease (ESRD) and death, compared to those patients without glomerular amyloid deposits. Patients with severe glomerular amyloidosis showed higher serum creatinine and urine protein levels, while patients with severe vascular amyloidosis showed higher levels of interstitial inflammatory infiltrate. Conclusion In kidneys affected by amyloidosis, the amyloid proteins are predominantly deposited along vessels, especially the small vessels including glomerular capillary loops. The severity of glomerular amyloid deposition enhances the risk of developing ESRD and increases the risk for premature death.
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Affiliation(s)
- Ekaterina Castano
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
| | - Matthew B Palmer
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
| | - Christine Vigneault
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Randy Luciano
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
| | - Gilbert Moeckel
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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13
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Talamo G, Mir Muhammad A, Pandey MK, Zhu J, Creer MH, Malysz J. Estimation of Daily Proteinuria in Patients with Amyloidosis by Using the Protein-To-Creatinine ratio in Random Urine Samples. Rare Tumors 2015; 7:5686. [PMID: 25918613 PMCID: PMC4387359 DOI: 10.4081/rt.2015.5686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022] Open
Abstract
Measurement of daily proteinuria in patients with amyloidosis is recommended at the time of diagnosis for assessing renal involvement, and for monitoring disease activity. Renal involvement is usually defined by proteinuria >500 mg/day. We evaluated the accuracy of the random urine protein-to-creatinine ratio (Pr/Cr) in predicting 24 hour proteinuria in patient with amyloidosis. We compared results of random urine Pr/Cr ratio and concomitant 24-hour urine collections in 44 patients with amyloidosis. We found a strong correlation (Spearman’s ρ=0.874) between the Pr/Cr ratio and the 24 hour urine protein excretion. For predicting renal involvement, the optimal cut-off point of the Pr/Cr ratio was 715 mg/g. The sensitivity and specificity for this point were 91.8% and 95.5%, respectively, and the area under the curve value was 97.4%. We conclude that the random urine Pr/Cr ratio could be useful in the screening of renal involvement in patients with amyloidosis. If validated in a prospective study, the random urine Pr/Cr ratio could replace the 24 hour urine collection for the assessment of daily proteinuria and presence of nephrotic syndrome in patients with amyloidosis.
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Affiliation(s)
| | | | | | - Junjia Zhu
- Milton S. Hershey Medical Center , Hershey, PA, USA
| | | | - Jozef Malysz
- Milton S. Hershey Medical Center , Hershey, PA, USA
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14
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Novel NLRP12 mutations associated with intestinal amyloidosis in a patient diagnosed with common variable immunodeficiency. Clin Immunol 2014; 154:105-11. [PMID: 25064839 DOI: 10.1016/j.clim.2014.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
Abstract
Heterozygous mutations in the NLRP12 gene have been found in patients with systemic auto-inflammatory diseases. However, the NLRP12-associated periodic fever syndromes show a wide clinical spectrum, including patients without classical diagnostic symptoms. Here, we report on a 20-year-old female patient diagnosed with common variable immunodeficiency (CVID), who developed intestinal amyloidosis and carried novel compound heterozygous mutations in NLRP12, identified by whole exome and transcriptome sequencing. CVID is a primary immunodeficiency characterized by low serum immunoglobulins, recurrent bacterial infections and development of malignancy, but it also presents with a magnitude of autoimmune features. Because of the unspecific heterogeneous clinical features of the disease, a delay in diagnosis is common. Secondary, inflammatory (AA type) amyloidosis has infrequently been observed in CVID patients. Based on our case observation and a critical review of the literature, we suggest that NLRP12 mutations might account for a small fraction of CVID patients with severe auto-inflammatory complications.
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15
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Chronic renal failure due to amyloid nephropathy caused by chronic infection after total hip replacement. CEN Case Rep 2014; 3:217-222. [PMID: 28509203 DOI: 10.1007/s13730-014-0121-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/26/2014] [Indexed: 10/25/2022] Open
Abstract
A 75-year-old woman was admitted to our hospital because of proteinuria, pitting edema on the foot, and renal impairment. She had undergone total hip replacement (THR) for femoral neck fracture at the age of 66. Nine years later, she met with an accident during farming and was treated at an emergency hospital for severe general trauma. On the basis of systemic symptoms, she was diagnosed with nephrotic syndrome. Renal biopsy by Congo-red staining and electron microscopy revealed amyloid deposition on glomeruli, interstitium, and interlobar arteries. The amyloid was immunohistochemically identified as AA amyloidosis. The patient eventually required maintenance hemodialysis because of impaired renal function. AA amyloidosis is an unusual complication of intractable inflammation. Chronic infection with abscess occurred around the artificial hip joint following THR and possibly induced secondary amyloidosis. THR is a common and necessary procedure adopted for femoral neck fracture. Orthopedic surgeons should, however, carefully monitor the occurrence of chronic infection after THR because such an infection could lead to renal dysfunction and/or failure via AA amyloidosis in rare cases.
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16
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Yavuz S, Ece A. Renal Amyloidosis Following Chronic Osteomyelitis in a Patient with Congenital Insensitivity to Pain and Anhidrosis. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojped.2014.43032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Gonzalo-Garijo MA, Sánchez-Vega S, Pérez-Calderón R, Pérez-Rangel I, Corrales-Vargas S, Fernández de Mera JJ, Robles R. Renal amyloidosis in a patient with X-linked agammaglobulinemia (Bruton's disease) and bronchiectasis. J Clin Immunol 2013; 34:119-22. [PMID: 24292696 DOI: 10.1007/s10875-013-9972-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/18/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis. CASE REPORT A 38 year-old man was diagnosed with X-linked agammaglobulinemia (Bruton's disease) when he was 3 years old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight. METHOD AND RESULTS Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria. Hepatitis B and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel's walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation. CONCLUSION We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis a finding rarely reported.
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Affiliation(s)
- M A Gonzalo-Garijo
- Department of Allergology and Clinical Immunology, Infanta Cristina University Hospital, Badajoz, Spain,
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18
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Panizo N, Rivera F, López-Gómez JM. Decreasing incidence of AA amyloidosis in Spain. Eur J Clin Invest 2013; 43:767-73. [PMID: 23683125 DOI: 10.1111/eci.12097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/22/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The main objectives of our study were to review all cases of amyloidosis diagnosed by renal biopsy in Spain from 1994 to 2009 and to analyse variations in the incidence over time. MATERIALS AND METHODS We analysed all biopsies from native kidneys included in the Spanish Registry of Glomerulonephritis. A total of 120 centres provided 17 680 biopsies over 16 years. Follow-up was divided in four periods. RESULTS We collected 653 cases of renal amyloidosis. In 438 cases (67%), amyloidosis type was specified, [AA amyloidosis, 253 cases (57·8%); AL amyloidosis, 185 cases (42·2%)]. Mean age was 60 (17·8) years; 51·4% of patients were younger than 65. Overall incidence was 3·7%. In patients < 65, AA amyloidosis was present in 66·1% and AL amyloidosis in 33·9% (P < 0·01). No differences were found in patients > 65. Patients with AA amyloidosis were younger (56·8 vs. 64·0, P < 0·01) and had worse creatinine clearance (35 vs. 57 mL/min, P < 0·01). We found a decrease in the incidence among biopsies collected during each of the 4 study periods (4·2%, 3·9%, 3·5% and 3·2%, respectively, P < 0·001). CONCLUSIONS This is the largest series of renal amyloidosis in kidney biopsies published to date. We found amyloidosis to be decreasing slowly in Spain. This decrease affects both types and is confirmed in all cases marked in patients < 65 and in AA type. AA amyloidosis was the most frequent in our series. Patients affected by it were younger and had worse kidney function, with no differences in the level of proteinuria.
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19
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Troxell ML, Griffiths R, Schnadig I, Houghton DC. Light chain renal amyloidosis with prominent giant cells. Am J Kidney Dis 2013; 62:1193-7. [PMID: 23891357 DOI: 10.1053/j.ajkd.2013.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 05/15/2013] [Indexed: 11/11/2022]
Abstract
Clinical diagnosis of amyloidosis may be very challenging because signs, symptoms, and laboratory study results can be highly variable and may overlap with other disease entities. Amyloid has characteristic features on kidney biopsy, involving glomeruli, vessels, and/or interstitium as typically amorphous waxy material that is periodic acid-Schiff pale and Congo Red birefringent under polarized light. Electron microscopy demonstrates characteristic randomly oriented fibrils. However, in rare cases, amyloid may present with atypical morphologic features on kidney biopsy, closely mimicking other histopathologic diagnoses. We present a case of light chain (AL) κ amyloidosis with an unusual inflammatory infiltrate including prominent multinucleated giant cells in the interstitium and at the glomerular hilus. Amyloid was apparent within giant cells on Congo Red staining, as well as on ultrastructural evaluation. Together with prior studies of tumoral nonrenal amyloid and renal amyloid A, we suggest that the amyloid fibril constituents κ and serum amyloid A have some predilection for inciting the rare multinucleated giant cell reaction.
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Affiliation(s)
- Megan L Troxell
- Department of Pathology, Oregon Health & Science University, Portland, OR.
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20
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Tang W, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, Clayton PA, Campbell SB, de Zoysa JR, Johnson DW. End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs492] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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A rare cause of secondary amyloidosis: common variable immunodeficiency disease. Case Rep Nephrol 2012; 2012:860208. [PMID: 24558615 PMCID: PMC3914192 DOI: 10.1155/2012/860208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/07/2012] [Indexed: 11/30/2022] Open
Abstract
The common variable immunodeficiency disease (CVID) is the most common symptomatic primary antibody deficiency. It is the most frequently observed cause of panhypogammaglobulinemia in adults. Here, we present a case of systemic amyloidosis that developed secondary to the common variable immunodeficiency disease causing recurrent infections in a young female patient. A 24-year-old female patient, who was under treatment at the gynecology and obstetrics clinic for pelvic inflammatory disease, was referred to our clinic when she was observed to have swellings in her legs, hands, and face. She had proteinuria at a rate of 3.5 gr/day, and her serum albumin was 1.5 gr/dl. The levels of immunoglobulins are IgG: 138 mg/dl, IgA: 22,6 mg/dl, and IgM: 16,8 mg/dl. The renal USG revealed that the kidneys were observed to be enlarged. Since the patient had recurrent infections, hypogammaglobulinemia, nephrotic range proteinuria, and enlarged kidneys in the renal USG, she was thought to have type AA amyloidosis and therefore underwent a renal biopsy. The kidney biopsy revealed amyloid (+). So the patient was diagnosed with AA type of amyloidosis secondary to common variable immunodeficiency disease. A treatment regimen (an ACE inhibitor and a statin) with monthly administration of intravenous immunoglobulin was started.
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22
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Prakash J, Brojen T, Rathore SS, Choudhury TA, Gupta T. The Changing Pattern of Renal Amyloidosis in Indian Subcontinent: Two Decades of Experience from a Single Center. Ren Fail 2012; 34:1212-6. [DOI: 10.3109/0886022x.2012.723514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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23
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Zhou LL, Cao W, Xie C, Tian J, Zhou Z, Zhou Q, Zhu P, Li A, Liu Y, Miyata T, Hou FF, Nie J. The receptor of advanced glycation end products plays a central role in advanced oxidation protein products-induced podocyte apoptosis. Kidney Int 2012; 82:759-70. [PMID: 22622498 DOI: 10.1038/ki.2012.184] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The accumulation of plasma advanced oxidation protein products (AOPPs) is prevalent in chronic kidney disease. We previously showed that accumulation of AOPPs resulted in podocyte apoptosis and their deletion by a cascade of signaling events coupled with intracellular oxidative stress. The transmembrane receptor that specifically transmits the AOPPs' signals to elicit cellular activity, however, remains unknown. Using co-immunoprecipitation and immunofluorescence, we found that AOPPs colocalized and interacted with the receptor of advanced glycation end products (RAGE) on podocytes. Blocking RAGE by anti-RAGE immunoglobulin G or its silencing by siRNA significantly protected podocytes from AOPPs-induced apoptosis both in vitro and in vivo and ameliorated albuminuria in AOPPs-challenged mice. AOPPs-induced activation of nicotinamide adenine dinucleotide phosphate oxidase and the excessive generation of intracellular superoxide were largely inhibited by anti-RAGE immunoglobulin G or RAGE siRNA. Moreover, blockade of RAGE decreased the activation of the p53/Bax/caspase-dependent proapoptotic pathway induced by AOPPs. Thus, AOPPs interact with RAGE to induce podocyte apoptosis and this, in part, may contribute to the progression of chronic kidney disease.
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Affiliation(s)
- Li Li Zhou
- Key Lab for Organ Failure Research, Ministry of Education, Division of Nephrology, Research Institute of Nephrology Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, China
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24
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Solak Y, Caymaz M, Tonbul HZ, Ozbek O, Turkmen K, Gormus N. Effects of secondary amyloidosis on arteriovenous hemodialysis fistula outcomes and intradialytic hypotension: a case-control study. Hemodial Int 2012; 16:401-6. [PMID: 22360544 DOI: 10.1111/j.1542-4758.2012.00673.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Amyloid fibrils can affect vascular structure through deposition and by causing nitric oxide depletion and increase of asymmetric dimethyl arginine. Patients with amyloidosis are prone to development of hypotension. Hypotension may also affect the maturation of arteriovenous fistula (AVF) and may set the stage for formation of thrombosis and fistula failure. Thus, we aimed to evaluate effects of secondary amyloidosis on AVF outcomes and intradialytic hypotension. This is a case-control study which included 20 hemodialysis patients with amyloidosis and 20 hemodialysis patients without amyloidosis as control group. All patients underwent Doppler ultrasound of AVF. A thorough fistula history and baseline laboratory values along with episodes of intradialytic hypotension and blood pressure measurements were recorded. There was no difference between the groups regarding age, gender, body mass index, presence of comorbidities, hypertension, and drug use. Systolic and diastolic blood pressures were similar (119 ± 28/75 ± 17 and 120 ± 14/75 ± 10 mmHg for patients with and without amyloidosis, respectively). Intradialytic hypotension episodes were also similar. Patients with amyloidosis had significantly lower serum albumin and higher C-reactive protein values compared to control hemodialysis patients. AVF sites and total number of created fistulas were similar in both groups. Flow rates of current functional AVFs were not different between the groups (1084 ± 875 and 845 ± 466 mL/minute for patients with and without amyloidosis, respectively, p:0.67). Patency duration of first AVF was not different between the groups. Clinical fistula outcomes and rate of intradialytic hypotension episodes were not significantly different between patients with and without secondary systemic amyloidosis.
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Affiliation(s)
- Yalcin Solak
- Division of Nephrology, Department of Internal Medicine, Meram School of Medicine, Selcuk University, Konya, Turkey.
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Significant association between renal function and area of amyloid deposition in kidney biopsy specimens in reactive amyloidosis associated with rheumatoid arthritis. Rheumatol Int 2011; 32:3155-62. [PMID: 21947375 DOI: 10.1007/s00296-011-2148-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
Abstract
The kidney is a major target organ for systemic amyloidosis, resulting in proteinuria and an elevated serum creatinine level. In patients with reactive amyloidosis associated with rheumatoid arthritis, a correlation between the amount of amyloid deposits and clinical parameters is not known. The purpose of this study was to clarify the association between various factors including renal function and the area of amyloid deposition in these patients. Fifty-eight patients with an established diagnosis of reactive AA amyloidosis were studied. We retrospectively investigated the correlation between clinical data and the area occupied by amyloid in renal biopsy specimens. All the patients showed amyloid deposits in renal tissues, and the percentage of the area occupied by amyloid was <10% in 54 of them. Mesangial proliferative glomerulonephritis and membranous nephropathy were frequently combined with renal amyloidosis. For statistical analyses, the percentage of the area occupied by amyloid was transformed to a common logarithmic value (Log(10) % amyloid), as the histograms showed a log-normal distribution. Log(10) % amyloid was found to be correlated with age, creatinine (Cr) level, creatinine clearance (Ccr), blood urea nitrogen (BUN) level, and the estimated glomerular filtration rate (eGFR). Multiple linear regression analyses were then performed to examine the sex- and age-adjusted association between Log(10) % amyloid and each of the clinical variables. Cr, Ccr, BUN, UA, CRP, and eGFR were significantly correlated with Log(10) % amyloid, but urinary protein was not. There was a significant correlation between the area of amyloid deposition in renal tissue and parameters of renal function, especially Cr and Ccr. If amyloid deposition in renal tissue can be arrested or prevented, then it may be possible to maintain renal function at an acceptable level.
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Abstract
Renal amyloidosis is a detrimental disease caused by the deposition of amyloid fibrils. A child with renal amyloidosis may present with proteinuria or nephrotic syndrome. Chronic renal failure may follow. Amyloid fibrils may deposit in other organs as well. The diagnosis is through the typical appearance on histopathology. Although chronic infections and chronic inflammatory diseases used to be the causes of secondary amyloidosis in children, the most frequent cause is now autoinflammatory diseases. Among this group of diseases, the most frequent one throughout the world is familial Mediterranean fever (FMF). FMF is typically characterized by attacks of clinical inflammation in the form of fever and serositis and high acute-phase reactants. Persisting inflammation in inadequately treated disease is associated with the development of secondary amyloidosis. The main treatment is colchicine. A number of other monogenic autoinflammatory diseases have also been identified. Among them cryopyrin-associated periodic syndrome (CAPS) is outstanding with its clinical features and the predilection to develop secondary amyloidosis in untreated cases. The treatment of secondary amyloidosis mainly depends on the treatment of the disease. However, a number of new treatments for amyloid per se are in the pipeline.
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Affiliation(s)
- Yelda Bilginer
- Hacettepe University Faculty of Medicine, Pediatric Nephrology and Rheumatology Unit, Ankara, Turkey
| | - Tekin Akpolat
- Department of Nephrology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Pediatric Nephrology and Rheumatology Unit, Ankara, Turkey
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Takahashi N, Kimura H, Yoshida H, Naiki H. [III. Paraproteinemia: 2. Amyloidosis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:1282-1288. [PMID: 21702145 DOI: 10.2169/naika.100.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Naoki Takahashi
- Division of Nephrology, Department of General Medicine, Faculty of Medical Sciences, University of Fukui, Japan
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28
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Ogawa K, Ikeda K, Furukawa M, Harada-Shirado K, Mashimo Y, Takahashi H, Matsumoto H, Kimura S, Shichishima-Nakamura A, Ohkawara H, Hashimoto Y, Asahi K, Noji H, Ohto H, Takeishi Y. A long-term remission of renal amyloidosis with nephrotic syndrome after autologous peripheral blood stem-cell transplantation. Fukushima J Med Sci 2011; 56:151-6. [PMID: 21502717 DOI: 10.5387/fms.56.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Renal amyloidosis is typically characterized by nephrotic syndrome, often with massive proteinuria and refractory peripheral edema. We report the case of a patient with renal amyloidosis associated with nephrotic syndrome who maintained remission for 6 years after undergoing high-dose chemotherapy followed by autologous peripheral blood stem-cell transplantation (auto-PBSCT). The patient was a man aged in his 50s who had developed nephrotic syndrome. Bone marrow aspiration and kidney biopsy determined that the cause of the nephrotic syndrome was renal amyloidosis due to multiple myeloma, and the patient was admitted to our department in July 2003. After one course of chemotherapy, auto-PBSCT was performed in March 2004. Following transplantation, serum M-protein was no longer detectable from March 2005, and the patient achieved complete hematological remission. Subsequently, proteinuria decreased, serum albumin levels normalized, and nephrotic syndrome improved. As of 6 years after transplantation, in March 2010, the patient remained in remission, meaning that auto-PBSCT proved extremely effective as a treatment for renal amyloidosis in this case.
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Affiliation(s)
- Kazuei Ogawa
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
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Localized tongue Amyloidosis in a Patient with Neurofibromatosis type II. Head Neck Pathol 2011; 5:302-5. [PMID: 21340708 PMCID: PMC3173546 DOI: 10.1007/s12105-011-0251-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Localized Amyloidosis (AL) may rarely involve oral mucosa. This is the first known reported case describing the development of tongue AL in a 30-year-old patient with Neurofibromatosis (NF) type-2. CASE A female patient presented with a painless, well-circumscribed nodule of the tongue. Her medical history included NF type-2 with chromosome-22 abnormal karyotype (mosaicism), multiple intracranial and spinal meningiomas/schwannomas and unilateral blindness/deafness. The biopsy of the excised lesion of the tongue revealed subepithelial accumulation of an amorphous, nodular, fibrillar material positive for Congo red. Blood examination showed increased Thyroxine-T4 due to thyroid multinodular colloid goiter, but excluded any other hematological/immunological disorder or organ dysfunction. No recurrence was observed after a six-month follow-up. CONCLUSION This case highlights the possibility of oral manifestations as the only sign of AL and reveals the unexpected co-existence of AL and NF 2, for the first time.
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30
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Tsai SF, Wen MC, Cheng CH, Wu MJ, Chen CH, Yu TM, Chuang YW, Huang ST, Shu KH. Clinical features of renal amyloidosis: an analysis of 40 patients in a 28-year follow-up. Intern Med 2011; 50:2511-7. [PMID: 22041350 DOI: 10.2169/internalmedicine.50.5822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Although rare, renal amyloidosis is an important diagnosis that bares a significant morbidity and mortality. The purpose of this study was to present current single center experience in the past 28 years. METHODS A total of 6151 kidney biopsies were performed in our hospital from Jan. 1983 to Dec. 2010; 5844 were native kidney biopsies. Cases with a diagnosis of renal amyloidosis were identified through a search of our data bank and the clinical data were retrieved from medical charts. The patients were further classified as AL type and non-AL type. The trend of incidence was analyzed and the clinical features were compared. Risk factors that predict patient mortality were discovered by logistic regression analysis. RESULTS Forty out of 5844 native kidney biopsies (0.68%) were identified as renal amyloidosis. Eighteen (45%) were of AL type. The mean age at diagnosis was 62.6 ± 13.4 years. Male was the predominant gender that was involved. Clinically, most (80%) have nephrotic range proteinuria (mean 24 hours urine protein: 6.9 ± 4.7 g). With a mean follow-up duration of 1155 day, the 1-year and 5-year patient survival were 42.9% and 17.9%, respectively. eGFR at biopsy was the sole predictive factor for patient survival. CONCLUSION Senile patients with nephrotic syndrome should elicit the suspicion of renal amyloidosis. The incidence appeared to be increasing and the prognosis poor.
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Affiliation(s)
- Shang-Feng Tsai
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
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Affiliation(s)
- Helen J Lachmann
- National Amyloidosis Centre, UCL Medical School, Royal Free Hospital Campus, London NW3 2PF
| | - Julian D Gillmore
- National Amyloidosis Centre, UCL Medical School, Royal Free Hospital Campus, London NW3 2PF
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D'Agati V, Yan SF, Ramasamy R, Schmidt AM. RAGE, glomerulosclerosis and proteinuria: roles in podocytes and endothelial cells. Trends Endocrinol Metab 2010; 21:50-6. [PMID: 19783154 DOI: 10.1016/j.tem.2009.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 01/30/2023]
Abstract
The multi-ligand Receptor for Advanced Glycation Endproducts (RAGE) is expressed in podocytes and endothelial cells in the human and murine glomerulus. Although present at low levels in homeostasis, RAGE expression is increased during disease. Pharmacological antagonism of RAGE or its genetic deletion imparts marked protection from podocyte effacement, albuminuria and glomerular sclerosis in disease models. In human subjects, associations between specific genetic polymorphisms of RAGE and levels of soluble forms of RAGE are linked to disease states in the kidney. In this review, we summarize the evidence from mouse to man, linking RAGE to the pathogenesis of nephropathy.
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Affiliation(s)
- Vivette D'Agati
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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KURODA TAKESHI, WADA YOKO, KOBAYASHI DAISUKE, MURAKAMI SHUICHI, SAKAI TAKEHITO, HIROSE SHINTARO, TANABE NAOHITO, SAEKI TAKAKO, NAKANO MASAAKI, NARITA ICHIEI. Effective Anti-TNF-α Therapy Can Induce Rapid Resolution and Sustained Decrease of Gastroduodenal Mucosal Amyloid Deposits in Reactive Amyloidosis Associated with Rheumatoid Arthritis. J Rheumatol 2009; 36:2409-15. [DOI: 10.3899/jrheum.090101] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To examine the effect of anti-tumor necrosis factor-α (anti-TNF) therapy in patients with reactive AA amyloidosis associated with rheumatoid arthritis (RA).Methods.Fourteen patients with reactive AA amyloidosis associated with RA were prospectively evaluated. Four patients were treated with infliximab and 10 with etanercept. The mean period of anti-TNF therapy was 20.1 ± 13.8 months. Laboratory findings and renal function were examined before and after initiation of anti-TNF therapy. In 9 patients the area of amyloid deposits in serial gastroduodenal mucosal biopsy specimens was examined and image analysis was performed.Results.C-reactive protein and serum amyloid A protein levels were significantly reduced after initiation of anti-TNF therapy. Twenty-four hour creatinine clearance improved in 4 patients, did not change in 5, and deteriorated in 3. Twenty-four hour urinary protein excretion was significantly decreased in 3 patients, not exacerbated in 6, and increased in 3 after initiation of anti-TNF therapy. The biopsy specimens from the 9 patients who underwent serial gastroduodenal biopsies showed significant decreases in the area of amyloid deposits, from 8.8% ± 6.4% to 1.6% ± 0.6% (p = 0.003) after initiation of anti-TNF therapy. Four patients showed a sustained decrease in the areas of amyloid deposits in their third biopsy specimens, and amyloid deposits were not detectable in 2.Conclusion.Our results indicate a striking effect of anti-TNF therapy for rapid removal and sustained disappearance of amyloid deposits in gastric mucosal tissue with amelioration of renal functions in patients with reactive amyloidosis due to RA.
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Helmchen U, Velden J, Kneissler U, Stahl R. Klinische Pathologie der renalen Amyloidosen. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11560-008-0180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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