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Feitosa V, Neves P, Jorge L, Noronha I, Onuchic L. Renal amyloidosis: a new time for a complete diagnosis. Braz J Med Biol Res 2022; 55:e12284. [PMID: 36197414 PMCID: PMC9529046 DOI: 10.1590/1414-431x2022e12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Amyloidoses are a group of disorders in which soluble proteins aggregate and deposit extracellularly in tissues as insoluble fibrils, causing organ dysfunction. Clinical management depends on the subtype of the protein deposited and the affected organs. Systemic amyloidosis may stem from anomalous proteins, such as immunoglobulin light chains or serum amyloid proteins in chronic inflammation or may arise from hereditary disorders. Hereditary amyloidosis consists of a group of rare conditions that do not respond to chemotherapy, hence the identification of the amyloid subtype is essential for diagnosis, prognosis, and treatment. The kidney is the organ most frequently involved in systemic amyloidosis. Renal amyloidosis is characterized by acellular pathologic Congo red-positive deposition of amyloid fibrils in glomeruli, vessels, and/or interstitium. This disease manifests with heavy proteinuria, nephrotic syndrome, and progression to end-stage kidney failure. In some situations, it is not possible to identify the amyloid subtype using immunodetection methods, so the diagnosis remains indeterminate. In cases where hereditary amyloidosis is suspected or cannot be excluded, genetic testing should be considered. Of note, laser microdissection/mass spectrometry is currently the gold standard for accurate diagnosis of amyloidosis, especially in inconclusive cases. This article reviews the clinical manifestations and the current diagnostic landscape of renal amyloidosis.
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Affiliation(s)
- V.A. Feitosa
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Divisão de Medicina Molecular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P.D.M.M. Neves
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Divisão de Medicina Molecular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.B. Jorge
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I.L. Noronha
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.F. Onuchic
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Divisão de Medicina Molecular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Ghosh S, Kala C, Garg A, Thakur AK. Amyloid deposition in granuloma of tuberculosis patients: A single-center pilot study. Tuberculosis (Edinb) 2022; 136:102249. [PMID: 35998384 DOI: 10.1016/j.tube.2022.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
The formation of granuloma is one of the characteristic features of tuberculosis. Besides, elevated serum amyloid A (SAA) protein level is the indicator for chronic inflammation associated with tuberculosis. The linkage between tuberculosis and SAA-driven secondary amyloidosis is well documented. However, SAA-derived amyloid onset and deposition start sites are not well understood in tuberculosis. We hypothesized that granuloma could be a potential site for amyloid deposition because of the presence of SAA protein and proteases, cleaving SAA into aggregation-prone fragments. 150 tuberculosis patients were identified and biopsies were collected from the affected organs. Patients showing eosinophilic hyaline-rich deposits within granuloma and its periphery were further screened for the presence of amyloid deposits. Upon Congo red staining, these hyaline deposits exhibited characteristic apple-green birefringence under polarized light, confirming their amyloid nature in 20 patients. Further upon Immuno-histochemical staining with anti-SAA antibody, the amyloid enriched areas showed positive immunoreactivity. In this pilot study, we have shown granuloma as a potential site for serum amyloid A derived amyloid deposition in tuberculosis patients. This study would expand the clinical and fundamental research for understanding the mechanism of amyloid formation in granuloma underlying tuberculosis and other chronic inflammatory conditions.
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Affiliation(s)
- Shreya Ghosh
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India; Mehta Family Center for Engineering in Medicine, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India
| | - Chayanika Kala
- Department of Pathology, LPS Institute of Cardiology and Cardiac Surgery, GSVM Medical College Kanpur, Uttar Pradesh, 208019, India
| | - Akansha Garg
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India; Mehta Family Center for Engineering in Medicine, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India
| | - Ashwani Kumar Thakur
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India; Mehta Family Center for Engineering in Medicine, Indian Institute of Technology Kanpur, Uttar Pradesh, 208016, India.
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Ayed A, Salem MB, Letaief A, Salah MB, Handous I, Hamouda M, Aloui S, Skhiri H. The Clinical Features and Outcomes of Renal Amyloidosis in Tunisia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:432-439. [PMID: 37843145 DOI: 10.4103/1319-2442.385967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Systemic amyloidosis is a rare disease characterized by clinical polymorphism. Indeed, the kidney is the most common organ involved and represents a real turning point in the disease. We aimed to determine the clinicopathological prognostic factors of renal amyloidosis (RA). We conducted a retrospective study including 40 cases with biopsy-proven RA collected in our department over a period of 10 years. Biochemical, demographic, and clinicopathological findings at diagnosis, as well as the follow-up data, were evaluated for each patient. The prevalence of amyloidosis was 2.7 per 100 nontransplant renal biopsies. The mean age at presentation was 55.5 ± 15.6 years with a male-to-female ratio of 1.85. The diagnosis of RA was confirmed by a renal biopsy in 85% of cases. Amyloid A (AA) amyloidosis was the most common type of amyloidosis (65%), and chronic infections ranked first in the panel of etiologies (41%). Amyloid light chain amyloidosis was mainly associated with multiple myeloma (57%). The median patient survival was 59 months versus 12 months for kidney survival. Age and extrarenal localization were independent predictors of mortality, whereas renal failure at presentation significantly influenced renal survival. The results of our study emphasize the rarity but also the severity of RA. AA amyloidosis was the most common type identified, which was mainly caused by chronic infections. Prevention remains the best solution until we can achieve therapeutic advances in inflammatory diseases.
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Affiliation(s)
- Amel Ayed
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Meriem Ben Salem
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ahmed Letaief
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Manel Ben Salah
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Insaf Handous
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mouna Hamouda
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Sabra Aloui
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Habib Skhiri
- Department of Nephrology, Dialysis and Kidney Transplantation, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Deshayes S, Aouba A, Grateau G, Georgin-Lavialle S. Infections and AA amyloidosis: An overview. Int J Clin Pract 2021; 75:e13966. [PMID: 33368925 DOI: 10.1111/ijcp.13966] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Amyloidoses are a heterogeneous group of systemic diseases characterised by extracellular accumulation of insoluble amyloid fibrils derived from unfolded proteins. Inflammatory (AA) amyloidosis can complicate various inflammatory disorders that are associated with a sustained acute phase response and serum amyloid A (SAA) protein overproduction. Chronic infections were the first recognised cause of amyloidoses. However, with the better management of underlying diseases, the frequency of AA amyloidosis is decreasing. PURPOSE The aim of this overview was to discuss the several infections associated with AA amyloidosis and the relative frequency of infections as aetiological factors. METHODS A search of the literature was performed using the PubMed database using the MeSH terms "Amyloidosis" and "Infections," from inception to December 31st, 2019. Articles written in other languages than English or French were excluded. RESULTS The frequency of AA amyloidosis secondary to infections decreased from more than 50% to less than 20% after the 2000s, with a parallel increase in the frequency of AA amyloidosis secondary to inflammatory diseases and to an unknown cause. CONCLUSION Whereas new antibiotics have been developed and sanitary conditions are better, infections still represent 5%-30% of the causes of AA amyloidosis, including in developed countries. These data argue for better screening of chronic infections to prevent AA amyloidosis and the development of new strategies to manage recurrent infections.
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Affiliation(s)
- Samuel Deshayes
- Service de médecine interne, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Achille Aouba
- Service de médecine interne, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Gilles Grateau
- Sorbonne Université, Service de médecine interne, GRC-28 (GRAASU), Centre national de référence des maladies autoinflammatoires et des amyloses inflammatoires (CEREMAIA), hôpital Tenon, AP-HP, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, Service de médecine interne, GRC-28 (GRAASU), Centre national de référence des maladies autoinflammatoires et des amyloses inflammatoires (CEREMAIA), hôpital Tenon, AP-HP, Paris, France
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Borg J, Buttigieg J, Holwill S, Azzopardi CM. Treatment of renal AA-Amyloidosis associated with human immunodeficiency virus infection: a case report. CEN Case Rep 2020; 10:88-93. [PMID: 32889702 DOI: 10.1007/s13730-020-00525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 01/30/2023] Open
Abstract
We present a case of a young adult male who was treated successfully for renal AA-amyloidosis secondary to human immunodeficiency virus (HIV) infection using highly active anti-retroviral therapy (HAART). He presented with lobar pneumonia, acute kidney injury, nephrotic syndrome and newly diagnosed HIV infection and was initiated on HARRT and haemodialysis. Kidney biopsy was consistent with amyloid deposition of the AA-type. His clinical condition improved gradually and after 10 months of therapy, he regained sufficient excretory function to become dialysis independent. Two years later, he remained well, with a recovered CD4 count and a glomerular filtration rate of 63 mL/min/1.73 m2. Patients with renal AA-amyloidosis typically present with slowly progressive chronic kidney disease, often leading to end-stage kidney disease within months. To our knowledge, this is the first reported case of biopsy proven renal AA-amyloidosis in a newly diagnosed HIV positive patient to present with acute kidney injury leading to dialysis dependence over a period of 2 weeks, which was successfully treated using HAART.
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Affiliation(s)
- Janice Borg
- Depatment of Medicine, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta.
| | - Jesmar Buttigieg
- Renal Division, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta
| | - Stephen Holwill
- Histopathology, Musgrove Park Hospital, Parkfield Dr, Taunton, TA1 5DA, UK
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Gupta N, Kaur H, Wajid S. Renal amyloidosis: an update on diagnosis and pathogenesis. PROTOPLASMA 2020; 257:1259-1276. [PMID: 32447467 DOI: 10.1007/s00709-020-01513-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
Amyloidosis is a diverse group of protein conformational disorder which is caused by accumulation and deposition of insoluble protein fibrils in vital tissues or organs, instigating organ dysfunction. Renal amyloidosis is characterized by the acellular Congo red-positive pathologic deposition of amyloid fibrils within glomeruli and/or the interstitium. It is generally composed of serum amyloid A-related protein or an immunoglobulin light chain; other rare forms lysozyme, gelsolin, fibrinogen alpha chain, transthyretin, apolipoproteins AI/AII/AIV/CII/CIII; and the recently identified form ALECT2. This disease typically manifests with heavy proteinuria, nephrotic syndrome, and finally progression to end-stage renal failure. Early diagnosis of renal amyloidosis is arduous as its symptoms appear in later stages with prominent amyloid deposition. The identification of the correct type of amyloidosis is quite troublesome as it can be confused with another related form. Therefore, the exact typing of amyloid is essential for prognosis, treatment, and correct management of renal amyloidosis. The emanation of new techniques of proteomic analysis, for instance, mass spectroscopy/laser microdissection, has provided greater accuracy in amyloid typing. This in-depth review emphasizes on the clinical features, renal pathological findings, and diagnosis of the AL and non-AL forms of renal amyloidosis.
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Affiliation(s)
- Nimisha Gupta
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Harshdeep Kaur
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Saima Wajid
- Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India.
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