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Horike K, Takeda A, Tsujita M, Goto N, Watarai Y, Uchida K, Katayama A, Nishihira M, Shimizu A, Nozu K, Morozumi K. Two novel APOA1
gene mutations in a Japanese renal transplant recipient with recurrent apolipoprotein A-I related amyloidosis. Nephrology (Carlton) 2018; 23 Suppl 2:17-21. [DOI: 10.1111/nep.13278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Keiji Horike
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | - Asami Takeda
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Makoto Tsujita
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Norihiko Goto
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yoshihiko Watarai
- Department of Kidney Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Kazuharu Uchida
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | - Akio Katayama
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
| | | | - Akira Shimizu
- Department of Pathology; Nippon Medical College; Tokyo Japan
| | - Kandai Nozu
- Department of Pediatrics; Kobe University; Kobe Japan
| | - Kunio Morozumi
- Department of Kidney Center; Masuko Memorial Hospital; Nagoya Japan
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Familial Mediterranean Fever Is Associated With Increased Mortality After Kidney Transplantation—A 19 Years' Single Center Experience. Transplantation 2017; 101:2621-2626. [DOI: 10.1097/tp.0000000000001681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Małyszko J, Kozłowska K, Małyszko JS. Amyloidosis: A cancer-derived paraproteinemia and kidney involvement. Adv Med Sci 2017; 62:31-38. [PMID: 28153807 DOI: 10.1016/j.advms.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/28/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
Abstract
Amyloidosis is the general term describing the extracellular tissue deposition of fibrils composed of low molecular weight subunits of a variety of proteins. There are multiple different human protein precursors of amyloid fibrils. Amyloid deposits are stained using Congo Red and show typical apple-green birefringence in polarized microscopy. Nowadays, a novel technique LMD/MS technique or laser microdissection combined with mass spectrometry help to diagnose amyloidosis. Amyloidosis of the kidney is typically classified as being either one of two types: AL or AA. Less common is the hereditary amyloidosis. Clinical manifestations are usually determined by the type of precursor protein, the tissue distribution, and the amount of amyloid deposition. Renal manifestation is usually present as asymptomatic proteinuria or clinically apparent nephrotic syndrome. In some patients clinical presentation include impaired kidney function with no or mild proteinuria. Patients with renal amyloidosis who progress to end-stage renal disease (ESRD) can be treated with either dialysis or renal transplantation. Diagnosis of amyloidosis is prerequisite to consider treatment options to avoid unnecessary chemotherapy. Treatment of amyloidosis is aimed at decreasing the precursors of fibrillary proteins and/or decrease in synthesis/deposition of amyloid fibrils. It depends upon the type of amyloidosis and cause of excess fibril production.
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Altindal M, Turkmen E, Yildirim T, Yilmaz R, Aki FT, Arici M, Altun B, Erdem Y. Kidney transplantation for end-stage renal disease secondary to familial Mediterranean fever. Clin Transplant 2016; 30:787-90. [PMID: 27101228 DOI: 10.1111/ctr.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 11/30/2022]
Abstract
Although kidney transplantation (KT) is widely used for treating renal amyloidosis secondary to familial Mediterranean fever (FMF), data concerning transplant outcome are limited and inconsistent. The aim of this study was to determine the long-term outcome of KT in patients with amyloidosis secondary to FMF. Kidney transplantation outcome in 24 patients with FMF was compared to that in 72 controls matched for age, gender of recipient, and type of the donor that underwent KT due to end-stage renal disease (ESRD) not caused by FMF. Mean follow-up time was 80.3 ± 55.1 months in the FMF group, vs. 86.5 ± 47.6 months in the control group. Death-censored graft survival at five and 10 yr in the FMF group was 95.8% and 78.4%, respectively, and was comparable to that in the control group. In the FMF group, five- and 10-yr patient survival (87.5 and 65.6%) was shorter than in the control group, but the difference was not statistically significant. The findings show that long-term outcome of KT in the patients with amyloidosis secondary to FMF was comparable to that in patients with ESRD not caused by FMF. Recurrence of amyloidosis in the allograft, gastrointestinal intolerance, and fatal infections remain as major complications during the post-transplant period.
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Affiliation(s)
- Mahmut Altindal
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Ercan Turkmen
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Tolga Yildirim
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Rahmi Yilmaz
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Fazil Tuncay Aki
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Mustafa Arici
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Bulent Altun
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Yunus Erdem
- Faculty of Medicine, Department of Nephrology, Hacettepe University, Ankara, Turkey
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Abedi A, Nakhjavani J, Etemadi J. Long-Term Outcome of Renal Transplantation in Patients With Familial Mediterranean Fever Amyloidosis: A Single-Center Experience. Transplant Proc 2013; 45:3502-4. [DOI: 10.1016/j.transproceed.2013.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rocha S, Lobato L, Carvalho MJ, Malheiro J, Vizcaíno R, Rodrigues A, Cabrita A. Renal transplantation in AA amyloidosis associated with Whipple's disease. Amyloid 2011; 18:240-4. [PMID: 21995309 DOI: 10.3109/13506129.2011.614651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Whipple's disease (WD) is a chronic infection caused by Thropheryma whipplei that usually manifests with intestinal, articular, pulmonary, neurological and cardiac abnormalities. Rarely, WD has been associated with renal AA amyloidosis.We report a 50 year-old male with nephrotic syndrome and renal failure whose renal biopsy revealed extensive AA amyloidosis. Amyloid was not found in other organs, namely in gastrointestinal tract and bone marrow. There was no evidence of chronic inflammatory disease, and despite detailed investigation, the diagnosis of the underlying disease remained obscure. Eight months after referral he started peritoneal dialysis. Three years later he developed anorexia, weight loss, anemia, and recurrent attacks of non-bloody diarrhea. A biopsy of the small intestine showed typical histological findings of WD and PCR was positive for T. whipplei. He was treated with ceftriaxone followed by co-trimoxazole, with remission of complaints and histological features. Three years later the patient underwent successful cadaveric kidney transplantation. In this case, AA amyloidosis preceded the manifestations of WD. To the best of our knowledge, this is the first report of kidney transplantation in a patient with amyloidosis due to WD. Recurrence of amyloidosis in renal graft is not expected.
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Affiliation(s)
- Sofia Rocha
- Department of Nephrology, Hospital de Santo António, Porto, Centro Hospitalar do Porto, Portugal.
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Emiroglu R, Başaran O, Pehlivan S, Ozdemir FN, Colak T, Moray G, Noyan T, Haberal M. Effect of Amyloidosis on Long-Term Survival in Kidney Transplantation. Transplant Proc 2005; 37:2967-8. [PMID: 16213276 DOI: 10.1016/j.transproceed.2005.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Amyloidosis is characterized by the accumulation of an amorphous material in various organs and tissues secondary to a variety of inflammatory, immune, infectious, and hereditary diseases. Since 1975, our transplantation team has performed 1470 renal transplantations. Between 1985 and July 2004, among 1159 kidney transplantations, 953 (82.3%) were from living donors and 206 (17.7%) from cadaveric donors. There were 32 recipients (28 men, 4 women; mean age, 31.4 +/- 1.7 years; range, 21 to 48 years) with amyloidosis, including, 28 (87.5%) who received grafts from living donors and 4 (12.5%) from cadaveric donors. Amyloidosis was secondary to familial Mediterranean fever in 22 (68.7%) patients and rheumatoid arthritis in 1 (3.1%). The remaining 9 (28.1%) patients had primary amyloidosis. The mean follow-up time was 51.2 +/- 5.7 months (range, 2-124 months). Mean HLA mismatch rate was 2.2 +/- 1. Twenty-six (81.2%) patients are alive at this time with functioning grafts, and a mean serum creatinine value of 2.1 +/- 1.5 ng/dL. The 1- and 5-year patient and graft survival rates were 90.6% and 84.3%, and 81.2% and 68.7%, respectively. We conclude that patients with amyloidosis may undergo kidney transplantation safely expecting outcomes similar to those patients who receive transplantations for other reasons.
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Affiliation(s)
- R Emiroglu
- Baskent University, Department of General Surgery, Transplantation Unit, Ankara, Turkey
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Sherif AM, Refaie AF, Sheashaa HA, El-Tantawy AE, Sobh MA. Long-term evaluation of neuromyopathy in live donor FMF amyloidotic kidney transplant recipients. Am J Nephrol 2004; 24:582-6. [PMID: 15557771 DOI: 10.1159/000082251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 10/13/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neuromyopathy was reported to be a problem among live donor familial Mediterranean fever (FMF) amyloid kidney transplant recipients. We aimed to address this issue on a long-term basis. METHODS 14 FMF amyloid live donor kidney transplant recipients with a mean post-transplant follow-up period of 82.43 +/- 50.1 months in comparison to a control group of 19 non-amyloid renal transplant patients were subjected to thorough neurological examination, laboratory and electrophysiologic studies. RESULTS Both groups were comparable with regard to mean serum creatinine levels cyclosporine doses (p > 0.05), however trough cyclosporine levels were significantly lower in the amyloidotics than the controls (p = 0.04). Serum creatine phosphokinase was comparable in both groups (p = 0.59). The amyloid patients showed significantly increased polyphasic motor unit potentials and abnormal interference patterns in the biceps brachii muscle (p = 0.03) and the abductor polices brevis muscle (p = 0.05). Multivariate analysis showed a significant level for biceps myopathy in amyloidotics (p = 0.001). Both groups attained no difference with regard to median nerve conduction velocity. CONCLUSION Electrophysiologically evidenced neuromyopathy is more liable to occur in long-term live donor FMF amyloidotic kidney transplant recipients than in the other non-amyloidotic kidney transplant recipients even with no clinical manifestations or high creatine phosphokinase levels.
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Affiliation(s)
- Ali M Sherif
- Nephrology Unit, Mansoura Urology and Nephrology Center, Mansoura, Egypt.
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Ozdemir BH, Ozdemir FN, Demirhan B, Turan M, Haberal M. Renal transplantation in amyloidosis: effects of HLA matching and donor type on recurrence of primary disease. Transpl Int 2004; 17:241-6. [PMID: 15175852 DOI: 10.1111/j.1432-2277.2004.tb00437.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Revised: 09/30/2003] [Accepted: 03/11/2004] [Indexed: 11/28/2022]
Abstract
The aim of this study is to evaluate the effect of HLA-matching and donor type on recurrence of amyloidosis after renal transplantation. The study includes 30 patients with systemic amyloidosis who received kidney transplants between 1985 and 2001. Donor source and HLA tissue typing of the donor and recipient were evaluated in each case. Of the 30 patients, 20 developed a recurrence of amyloidosis in their allografts, as confirmed by biopsy. The time from transplantation to diagnosis of amyloidosis in the graft ranged from 18 months to 10 years. Of the 20 patients with recurrence, 18 had received their grafts from living related donors (LRDs), and 2 had received their grafts from cadaveric donors (P < 0.01). There was a strong correlation between amyloidosis recurrence and degree of HLA-DR matching (P < 0.05). Furthermore, in the recipients of LRD grafts, the risk of amyloidosis recurrence was much higher if the donor-recipient pair were HLA-identical than if they were not perfectly matched (P < 0.01). The incidence of amyloidosis recurrence in our patients was significantly higher than the rates reported for other series. Most of the cases in previous reports involved cadaveric grafts. The higher rate of amyloidosis recurrence in our patients may be explained by the high proportion of LRD grafts and by genetic susceptibility.
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Affiliation(s)
- Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey.
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Abstract
Apolipoprotein AII (ApoAII) amyloidosis, first reported in 2001 in a family with renal amyloidosis, is associated with mutations in the stop codon of the apolipoprotein AII gene resulting in a carboxyl terminal peptide extension of 21 amino acid residues in the protein. Since death from this form of amyloidosis is due to renal failure, kidney dialysis and renal transplantation are presently the only two therapeutic options. We report the case of a Caucasian man who developed proteinuria in his late 20's, had renal biopsy at the age of 33 which gave the diagnosis of renal amyloidosis, and required continuous ambulatory peritoneal dialysis by age 45. He received a cadaver renal transplant at age 47 and has maintained stable renal function for nine years without other evidence for organ system dysfunction from amyloidosis. Laboratory studies confirmed persistence of the ApoAII variant in the patient's plasma in addition to the normal ApoAII protein. This is in agreement with the DNA analysis which showed the patient to be heterozygous for the ApoAII stop78Gly mutation. These results indicate that renal transplantation is an effective therapy for apolipoprotein AII amyloidosis since recurrence of amyloid in the graft and progression of other organ involvement may be very slow.
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Affiliation(s)
- Nadine Magy
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 975 West Walnut Street, IB-503, Indianapolis, Indiana, 46202 USA
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Tweezer-Zaks N, Langevitz P, Livneh A. Long-term followup needed to define role of infliximab in treatment of renal amyloidosis: Comment on the case report by Elkayam et al. ACTA ACUST UNITED AC 2003; 48:3298-9; author reply 3299-300. [PMID: 14613300 DOI: 10.1002/art.11316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sherif AM, Refaie AF, Sobh MAK, Mohamed NAH, Sheashaa HA, Ghoneim MA. Long-term outcome of live donor kidney transplantation for renal amyloidosis. Am J Kidney Dis 2003; 42:370-5. [PMID: 12900821 DOI: 10.1016/s0272-6386(03)00676-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The short-term outcome of kidney transplantation in patients with amyloidosis has been reported. The aim of this study is to investigate long-term results in patients with renal amyloidosis. METHODS We studied results of renal transplantation in 23 amyloidotic transplant recipients compared with those in a control group of 47 nonamyloidotic patients. Amyloidosis was secondary to familial Mediterranean fever (FMF) in 16 patients, whereas it was primary (idiopathic) in 7 transplant recipients. The 2 groups were homogeneous regarding age, sex, HLA matching, immunosuppression, and duration of transplantation. RESULTS Five- and 10-year actuarial graft survival rates were similar in both groups (79.35% versus 84.04% and 65.92% versus 56.61%, respectively ). Five- and 10-year actuarial patient survival rates also were similar (80% versus 94% and 68% versus 87%, respectively). Moreover, 72.4% of controls experienced at least 1 rejection episode, whereas only 43.5% of amyloidotic transplant recipients experienced 1 or more such events (P = 0.02). Nonetheless, mean serum creatinine concentrations did not differ between the 2 groups during the observation period. Maintenance colchicine therapy prevented the recurrence of both FMF symptoms and amyloidosis. Recurrence was documented in only 1 amyloidotic transplant recipient (4.3%) 10 years posttransplantation. Significant gastrointestinal (GI) problems were more frequent in amyloidotic patients (65% versus 38%; P = 0.03). Amyloidotic patients with GI problems, except for 2 patients, were administered cyclosporine. Eleven of these patients had FMF, which appeared to reflect the effects of both cyclosporine and colchicine. Infections were similar in the groups; whereas amyloidotic patients had significantly lower blood pressures. CONCLUSION In our experience, long-term (5 to 10 years) outcome of live related donor kidney transplantation in patients with amyloidosis is similar to that in the general transplant population.
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Sever MS, Turkmen A, Sahin S, Yildiz A, Ecder T, Kayacan MS, Nane I, Aydin AE, Eldegez U. Renal transplantation in amyloidosis secondary to familial Mediterranean fever. Transplant Proc 2001; 33:3392-3. [PMID: 11750451 DOI: 10.1016/s0041-1345(01)02461-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M S Sever
- Istanbul School of Medicine, Istanbul, Turkey
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Bora S, Erkan N, Haciyanli M, Soylu A, Kavukçu S, Gülay H. Renal transplantation in patients with amyloidosis. Transplant Proc 2000; 32:605-6. [PMID: 10812135 DOI: 10.1016/s0041-1345(00)00913-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Bora
- Faculty of Medicine, Departments of General Surgery and Pediatric Nephrology, Dokuz Eylul University, Izmir, Turkey
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Nowak G, Westermark P, Wernerson A, Herlenius G, Sletten K, Ericzon BG. Liver transplantation as rescue treatment in a patient with primary AL kappa amyloidosis. Transpl Int 2000. [DOI: 10.1111/j.1432-2277.2000.tb01047.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Karakayali H, Demirag A, Moray G, Ersoy E, Turan M, Bilgin N, Haberal M. Impact of amyloidosis on long-term survival in kidney transplantation. Transplant Proc 1999; 31:3221-3. [PMID: 10616451 DOI: 10.1016/s0041-1345(99)00700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H Karakayali
- Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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