1
|
Ozdag Y, Koshinski JL, Carry BJ, Gardner JM, Garcia VC, Dwyer CL, Akoon A, Klena JC, Grandizio LC. A Comparison of Amyloid Deposition in Endoscopic and Open Carpal Tunnel Release. J Hand Surg Am 2024; 49:301-309. [PMID: 38363261 DOI: 10.1016/j.jhsa.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Previous investigations assessing the incidence of amyloidosis detected with biopsy during carpal tunnel release (CTR) have focused on open CTR (OCTR). Prior authors have suggested that biopsy may be more technically challenging during endoscopic carpal tunnel release (ECTR). Our purpose was to compare differences in the incidence of amyloid deposition detected during ECTR versus OCTR. METHODS We reviewed all primary ECTR and OCTR during which a biopsy for amyloid was obtained between February 2022 and June 2023. All procedures were performed by five upper-extremity surgeons from a single institution. Congo red staining was used to determine the presence of amyloid deposition in either the transverse carpal ligament (TCL) or tenosynovium. All positive cases underwent subtype analysis and protein identification through liquid chromatography-tandem mass spectrometry. Baseline demographics were recorded for each case, and the incidence of positive biopsy was compared between ECTR and OCTR cases. RESULTS A total of 282 cases were included for analysis (143 ECTR and 139 OCTR). The mean age was 67 years, and 45% of cases were women. Baseline demographics were similar except for a significantly higher incidence of diabetes in OCTR cases (13% vs 33%). Overall, 13% of CTR cases had a positive biopsy. There was a statistically significant difference in the incidence of amyloid deposition detected during biopsy in ECTR cases (3.5%) compared with OCTR cases (23%). CONCLUSIONS Biopsy performed during ECTR may result in a lower incidence of amyloid detection. Future basic science investigation may be necessary to determine histologic differences between tenosynovium proximal and distal to the leading edge of the TCL. When surgeons plan a biopsy during surgical release of the carpal tunnel, an open approach may be advantageous. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Yagiz Ozdag
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Jessica L Koshinski
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Brendan J Carry
- Department of Cardiology, Heart Institute, Geisinger Health System, Danville, PA
| | - Jerad M Gardner
- Departments of Laboratory Medicine and Dermatology, Geisinger Health System, Danville, PA
| | - Victoria C Garcia
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - C Liam Dwyer
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Anil Akoon
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Al-Obaidy KI, Grignon DJ. Primary Amyloidosis of the Genitourinary Tract. Arch Pathol Lab Med 2021; 145:699-703. [PMID: 32383975 DOI: 10.5858/arpa.2020-0102-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Amyloidosis is caused by the deposition of misfolded proteins as insoluble eosinophilic material in the extracellular tissues of the body, leading to impairment of organ function. It can be systemic or localized. Localized genitourinary tract amyloidosis is rare and can be incidentally seen; however, in some cases, it can be the only presenting disease. OBJECTIVE.— To review the clinical presentation and pathologic findings related to primary amyloidosis of the urogenital system and highlight some of the associated pathologic findings based on our personal experience. DATA SOURCES.— Published peer-reviewed literature and personal experience of the senior author. CONCLUSIONS.— Primary localized amyloidosis within the urogenital tract can present as a neoplastic process and may be clinically and radiologically considered as a mass. Awareness of primary amyloidosis by pathologists and clinicians is required for accurate diagnosis and proper patient management.
Collapse
Affiliation(s)
- Khaleel I Al-Obaidy
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| | - David J Grignon
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| |
Collapse
|
4
|
Lysyl oxidase inhibitors attenuate cyclosporin A-induced nephropathy in mouse. Sci Rep 2021; 11:12437. [PMID: 34127702 PMCID: PMC8203624 DOI: 10.1038/s41598-021-91772-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/17/2021] [Indexed: 01/05/2023] Open
Abstract
Calcineurin inhibitors, such as Cyclosporin (CsA), are the mainstay of anti-rejection therapy in solid organ transplants but can paradoxically induce progressive nephropathy characterised by renal dysfunction and interstitial fibrosis. Lysyl oxidases (LOXs), a group of enzymes that catalyse extracellular matrix (ECM) crosslinking, were shown to implicate in tissue scarring. It is hypothesized that inhibition of these enzymes may render therapeutic effects against CsA-induced nephropathy. In this study, 6-to-8 weeks old C57BL/6 J mice were administered saline or CsA (30 mg/kg/day s.c) for 16 weeks. At 8 weeks, CsA-treated animals were divided into 5 groups respectively treated with: (1) vehicle, (2) PXS-5505 (Pan-LOX inhibitor), (3) PXS-5382 (LOX-like 2 inhibitor), (4) PXS-5505 for 4 weeks then PXS-5382 for 4 weeks (sequential therapy), and (5) Telmisartan (standard therapy). Our results indicate that CsA administration significantly increased the levels of blood urea nitrogen, glomerular and tubular injury, tubulointerstitial fibrosis, inflammation and oxidative stress in mouse kidney. These changes were associated with upregulated mRNA expression of LOX and LOXL2. Administration of Pan-LOX or LOXL2 inhibitors or the sequential therapy suppressed the expression of ECM proteins (α-SMA, FN and COL1A), matrix metalloproteases (MMP)2 and 9, inflammatory markers (TNFα and MCP-1) and TGF-β1-Smad3 signalling. Among all regimens including telmisartan, only Pan-LOX inhibitor PXS-5505 was able to attenuate uraemia. Collectively, our study suggests that Pan-LOX and LOXL2 inhibition can attenuate progressive nephropathy due to CsA administration.
Collapse
|
5
|
Simsek C, Karatas M, Tatar E, Yildirim AM, Alkan FT, Uslu A. The efficacy of interleukin-1 antagonist drugs in combination with colchicine in patients with FMF-AA with colchicine resistance after kidney transplantation: A study with histopathologic evidence. Clin Transplant 2021; 35:e14309. [PMID: 33813772 DOI: 10.1111/ctr.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy of anti-interleukin-1 (IL-1) drugs in kidney transplant patients with FMF-AA who developed colchicine resistance has not been clearly demonstrated. METHOD Thirty nine kidney transplant recipients with FMF-AA were evaluated. Group 1 consisted of patients who were in remission after transplantation with colchine and Group 2 included those who developed colchicine resistance. RESULTS The mean follow-up of the patients was 88.5 ± 61.9 months. Following the treatment with IL-1 antagonists; serum Amyloid A (SAA) averages (79.4 ± 35.3 mg/L) as well as the average number of hospitalizations per month due to FMF episodes (1.4 ± 0.5 times/month) decreased significantly (26.6 ± 25.9 mg/L and 0.1 ± 0.3 times/month) (p < .001). Rates of death with a functional graft were 30% and 0% in group 1 and 2 (p = .086). Biopsy-proven AA amyloidosis recurrence in the allograft was observed in 11 of 19 (58%) and seven of nine (78%) patients in group 1 and 2, respectively. Interestingly, glomerular amyloid deposition was not present in the vast majority of biopsies. De novo vasculer amyloid deposition was observed during treatment. CONCLUSION IL-1 antagonist drug and colchicine combination almost completely prevented acute FMF attacks in kidney transplant patients with colchicine resistance. However, amyloid accumulation did not cease during IL-1 antagonist drug treatment.
Collapse
Affiliation(s)
- Cenk Simsek
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Murat Karatas
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Erhan Tatar
- Department of Nephrology and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Ali Murat Yildirim
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Funda Tasli Alkan
- Department of Pathology, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Adam Uslu
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| |
Collapse
|
6
|
Fan Y, Liang D, Rui H, Xu F, Xia Y, Yang F, Liang S, Zhu X, Zhang M, Huang X, Zeng C. Using digital whole-slide images to evaluate renal amyloid deposition and its association with clinical features and outcomes of AL amyloidosis. J Nephrol 2021; 34:1747-1756. [PMID: 33651314 DOI: 10.1007/s40620-020-00948-1] [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: 05/14/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few data are available quantifying the proportion of amyloid deposition in renal biopsy specimens. The aim of the study is to investigate the correlation between the proportion of amyloid deposition in renal biopsy and clinical characteristics of Chinese patients with immunoglobulin light-chain amyloidosis (AL amyloidosis). METHODS 259 patients diagnosed with renal AL amyloidosis between 2003 and 2015 were studied retrospectively. We developed a digital, automated quantification method to evaluate amyloid deposits in glomeruli, vessels and interstitium on digital whole-slide images (WSIs). The associations between the proportion of amyloid-positive area in the renal biopsy and clinical manifestations were analyzed. RESULTS The proportion (%) of amyloid-positive area in glomeruli, vessels, interstitium and the whole renal tissue were 11.81 ± 11.38, 14.14 ± 14.05, 3.34 ± 5.36 and 4.25 ± 5.77, respectively. The proportion of amyloid deposition in glomeruli, vessels and interstitium was positively correlated with serum creatinine (Scr), estimated glomerular filtration rate (eGFR) and urinary retinol binding protein (RBP). The proportion of glomerular amyloid deposition, age, urinary N-acetyl-b-D-glucosaminidase (NAG) and urinary RBP could independently predict the risk for overall death. The proportion (%) of amyloid-positive area in blood vessels, interstitium and the whole renal tissue, Scr, and urinary RBP were independent risk factors associated with renal survival. CONCLUSION A novel digital analysis algorithm was firstly developed to quantify the proportion of amyloid deposits in renal tissues based on digital WSIs. The degree and localization of amyloid deposits in the kidney evaluated by digital WSIs may have predictive value in assessing risk of outcome of AL amyloidosis.
Collapse
Affiliation(s)
- Yun Fan
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Dandan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Haochen Rui
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Yuanyuan Xia
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Fan Yang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Xiaodong Zhu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Mingchao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Xianghua Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China.
| |
Collapse
|
7
|
Perampalam P, Hassan HM, Lilly GE, Passos DT, Torchia J, Kiser PK, Bozovic A, Kulasingam V, Dick FA. Disrupting the DREAM transcriptional repressor complex induces apolipoprotein overexpression and systemic amyloidosis in mice. J Clin Invest 2021; 131:140903. [PMID: 33444292 DOI: 10.1172/jci140903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
DREAM (Dp, Rb-like, E2F, and MuvB) is a transcriptional repressor complex that regulates cell proliferation, and its loss causes neonatal lethality in mice. To investigate DREAM function in adult mice, we used an assembly-defective p107 protein and conditional deletion of its redundant family member p130. In the absence of DREAM assembly, mice displayed shortened survival characterized by systemic amyloidosis but no evidence of excessive cellular proliferation. Amyloid deposits were found in the heart, liver, spleen, and kidneys but not the brain or bone marrow. Using laser-capture microdissection followed by mass spectrometry, we identified apolipoproteins as the most abundant components of amyloids. Intriguingly, apoA-IV was the most detected amyloidogenic protein in amyloid deposits, suggesting apoA-IV amyloidosis (AApoAIV). AApoAIV is a recently described form, whereby WT apoA-IV has been shown to predominate in amyloid plaques. We determined by ChIP that DREAM directly regulated Apoa4 and that the histone variant H2AZ was reduced from the Apoa4 gene body in DREAM's absence, leading to overexpression. Collectively, we describe a mechanism by which epigenetic misregulation causes apolipoprotein overexpression and amyloidosis, potentially explaining the origins of nongenetic amyloid subtypes.
Collapse
Affiliation(s)
- Pirunthan Perampalam
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Biochemistry, Western University, London, Ontario, Canada
| | - Haider M Hassan
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Grace E Lilly
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Biochemistry, Western University, London, Ontario, Canada
| | - Daniel T Passos
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Joseph Torchia
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Biochemistry, Western University, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Patti K Kiser
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Andrea Bozovic
- Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Vathany Kulasingam
- Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Frederick A Dick
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
| |
Collapse
|
8
|
Abd-El-Aziz AS, Abdelghani AA, El-Ghezlani EG, Abou El-Ezz D, Abdel-Rahman LH. Pharmacological Evaluation of Novel Organoiron Dendrimers as Antimicrobial and Anti-Inflammatory Agents. Macromol Biosci 2020; 21:e2000242. [PMID: 33063474 DOI: 10.1002/mabi.202000242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/23/2020] [Indexed: 11/11/2022]
Abstract
The synthesis of a novel and attractive class of nonsteroidal anti-inflammatory and antimicrobial organoiron dendrimers attached to the well-known drug ibuprofen is achieved. The structures of these dendrimers are established by spectroscopic and analytical techniques. The antimicrobial activity of these dendrimers is investigated and tested against five human pathogenic Gram-positive and Gram-negative bacteria, and minimum inhibitory concentrations are reported. Some of these synthesized dendrimers exhibit higher inhibitory activity against methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and Staphylococcus warneri compare to the reference drugs. As well, the in vitro and in vivo anti-inflammatory activities of these dendrimers are evaluated. The results of in vivo anti-inflammatory activity and histopathology of inflamed paws show that all dendrimers display considerable anti-inflammatory activity; however, second-generation dendrimer (G2-D6) shows the best anti-inflammatory activity, which is more potent than the commercial drug ibuprofen at the same tested dose. Results of the toxicity study reveal that G2-D6 is the safest drug on biological tissues.
Collapse
Affiliation(s)
- Alaa S Abd-El-Aziz
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Amani A Abdelghani
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Ebtehal G El-Ghezlani
- Department of Chemistry, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Doaa Abou El-Ezz
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA University), Giza, 12566, Egypt
| | | |
Collapse
|
9
|
Celtik A, Sen S, Keklik F, Saydam G, Asci G, Sarsik B, Ozkahya M, Toz H. A histopathological scoring and grading system to predict outcome for patients with AA amyloidosis. Int Urol Nephrol 2020; 52:1297-1304. [PMID: 32529382 DOI: 10.1007/s11255-020-02505-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Renal involvement is associated with significant morbidity and mortality in AA amyloidosis. Extend of amyloid deposition in kidney biopsies may be predictive for clinical manifestations and outcomes. The aim of our study is to assess clinical features of patients with biopsy-proven renal AA amyloidosis and to evaluate the relationship between histopathological scoring and grading of renal amyloid deposition with clinical findings and outcomes. METHODS The study included 86 patients who were diagnosed with renal AA amyloidosis. The demographic and clinical features at the time of biopsy and follow-up data were retrospectively collected. Amyloid deposition in glomeruli, interstitium, vessels and tubulointerstitial findings were scored and renal amyloid prognostic score (RAPS) was assigned by adding all scores. RAPS was further divided into three grades (RAPS grade I, II, III). RESULTS Median age was 50 (36-59) years. Familial Mediterranean fever was the leading cause. RAPS grade and interstitial inflammatory infiltration were associated with baseline eGFR and glomerular amyloid deposition was associated with proteinuria. During the follow-up period (median 50 months), 39 patients developed ESRD. Extensive (involving > 50%) glomerular amyloid deposition, baseline eGFR and proteinuria were independent risk factors for progression to end stage renal disease. Death censored renal survival was significantly lower among patients with RAPS grade III compared to those with RAPS grade I and II. Patient survival rate was not different according to RAPS grade. CONCLUSIONS Degree of renal amyloid accumulation is associated with renal function and outcome. The scoring and grading system may be predictive in clinical outcome and contribute to understanding of disease mechanism.
Collapse
Affiliation(s)
- Aygul Celtik
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Sait Sen
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
| | - Fatma Keklik
- Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Guray Saydam
- Division of Hematology, Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Gulay Asci
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
| | - Banu Sarsik
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
| | - Mehmet Ozkahya
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
| | - Huseyin Toz
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
| |
Collapse
|
10
|
Fonseca EO, Caldas MLR, Soares Filho PJ, Almeida JR. Correlation between amyloid deposits affecting renal compartments and glomerular filtration rate during renal biopsy in a renal amyloidosis case series. ACTA ACUST UNITED AC 2020; 53:e8625. [PMID: 32428129 PMCID: PMC7266501 DOI: 10.1590/1414-431x20208625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
Abstract
Amyloidosis comprises a group of disorders that accumulate modified autologous proteins in organs, mainly the kidneys. Few studies have addressed the amyloid compartmental distribution and associated clinical outcomes. The aim of this study was to present a case series of renal amyloidosis correlating histopathological data with glomerular filtration rate (GFR) during kidney biopsy. We studied 53 cases reviewed by nephropathologists from 2000 to 2018 in a single kidney biopsy center in Brazil. GFR was estimated using the CKD-EPI formula. Cases were divided into Group A ≥60 and Group B <60 mL·min−1·(1.73 m2)−1 using the estimated GFR during kidney biopsy. Semiquantitative histopathological study was performed, including extension and distribution of amyloid deposits by compartments (glomeruli, tubulointerstitial tissue, and vessels). Statistical analyses were made to understand associations with lower GFR. No difference was seen for age, gender, proteinuria, hematuria, subtype of amyloid protein, arteriosclerosis, interstitial fibrosis/infiltrate, or glomerular and interstitial amyloid deposits. After a previous P value <0.1 in the descriptive analysis, the following variables were selected: globally sclerotic glomeruli, high blood pressure, and the extension of vascular amyloid deposition. A binary logistic regression model with GFR as the dependent variable showed history of hypertension and vascular amyloid to be robust and independent predictors of Group B <60 mL·min−1·(1.73 m2)−1. Beyond the histopathologic diagnosis of amyloidosis, a semiquantitative approach on renal biopsy could provide new insights. Vascular amyloid is an independent predictor of renal dysfunction in cases of renal amyloidosis.
Collapse
Affiliation(s)
- E O Fonseca
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - M L R Caldas
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - P J Soares Filho
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - J R Almeida
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil
| |
Collapse
|
11
|
Hoelbeek JJ, Kers J, Steenbergen EJ, Roelofs JJTH, Florquin S. Renal amyloidosis: validation of a proposed histological scoring system in an independent cohort. Clin Kidney J 2020; 14:855-862. [PMID: 33777368 PMCID: PMC7986350 DOI: 10.1093/ckj/sfaa019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/17/2020] [Indexed: 01/28/2023] Open
Abstract
Background In systemic amyloidosis, the kidney is frequently affected and renal involvement has a major impact on survival. Renal involvement is clinically characterized by decreased estimated glomerular filtration rate (eGFR) and proteinuria. The two most common renal amyloidosis types are light chain-related amyloidosis (AL) and serum amyloid A (AA) amyloidosis. Standardized histopathological scoring of amyloid deposits is crucial to assess disease progression. Therefore, we aimed to validate the proposed scoring system from Rubinstein et al. (Novel pathologic scoring tools predict end-stage kidney disease in light chain (AL) amyloidosis. Amyloid 2017; 24: 205–211) in an independent patient cohort. Methods We attempt to reproduce the scoring system, consisting of an amyloid score (AS) and a composite scarring injury score (CSIS), in a multicentre AL and AA case series. Additionally, we analysed all renal amyloidosis kidney biopsies performed in the Netherlands between 1993 and 2012. Results Similar to the original study, AS and CSIS correlated to eGFR (r = −0.45, P = 0.0061 and r = −0.60, P < 0.0001, respectively) but not to proteinuria at diagnosis. Furthermore, AS, but not CSIS, was associated with renal outcome. The scoring system was not reproducible in AA patients. The median incidence rate for renal amyloidosis in the Netherlands was 2.3 per million population per year, and increased during the study period. Conclusions In our AL case series and the original study, AS and CSIS were correlated to eGFR but not to proteinuria, and AS correlated with renal outcome. Overall, we regard this scoring system as competent for standardized histopathological assessment of amyloid deposits burden and thereby disease advancement in renal biopsies.
Collapse
Affiliation(s)
- Joris J Hoelbeek
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesper Kers
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric J Steenbergen
- Department of Pathology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Kalle A, Gudipati A, Raju SB, Kalidindi K, Guditi S, Taduri G, Uppin MS. Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience. J Lab Physicians 2020; 10:226-231. [PMID: 29692592 PMCID: PMC5896193 DOI: 10.4103/jlp.jlp_148_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION: Kidney involvement is a major cause of mortality in systemic amyloidosis. Glomerulus is the most common site of deposition in renal amyloidosis, and nephrotic syndrome is the most common presentation. Distinction between AA and AL is done using immunofluorescence (IF) and immunohistochemistry (IHC). Renal biopsy helps in diagnosis and also predicting the clinical course by applying scoring and grading to the biopsy findings. MATERIALS AND METHODS: The study includes all cases of biopsy-proven renal amyloidosis from January 2008 to May 2017. Light microscopic analysis; Congo red with polarization; IF; IHC for Amyloid A, kappa, and lambda; and bone marrow evaluation were done. Classification of glomerular amyloid deposition and scoring and grading are done as per the guidelines of Sen S et al. RESULTS: There are 40 cases of biopsy-proven renal amyloidosis with 12 primary and 23 secondary cases. Mean age at presentation was 42.5 years. Edema was the most common presenting feature. Secondary amyloidosis cases were predominant. Tuberculosis was the most common secondary cause. Multiple myeloma was detected in four primary cases. Grading of renal biopsy features showed a good correlation with the class of glomerular involvement. CONCLUSION: Clinical history, IF, and IHC are essential in amyloid typing. Grading helps provide a subtle guide regarding the severity of disease in the background of a wide range of morphological features and biochemical values. Typing of amyloid is also essential for choosing the appropriate treatment.
Collapse
Affiliation(s)
- Abhiram Kalle
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Archana Gudipati
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Karthik Kalidindi
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Swarnalatha Guditi
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gangadhar Taduri
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
13
|
Rubinstein S, Cornell RF, Du L, Concepcion B, Goodman S, Harrell S, Horst S, Lenihan D, Slosky D, Fogo A, Langone A. Novel pathologic scoring tools predict end-stage kidney disease in light chain (AL) amyloidosis. Amyloid 2017; 24:205-211. [PMID: 28758811 DOI: 10.1080/13506129.2017.1360272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Light chain (AL) amyloidosis frequently involves the kidney, causing significant morbidity and mortality. A pathologic scoring system with prognostic utility has not been developed. We hypothesized that the extent of amyloid deposition and degree of scarring injury on kidney biopsy, could provide prognostic value, and aimed to develop pathologic scoring tools based on these features. METHODS This is a case-control study of 39 patients treated for AL amyloidosis with biopsy-proven kidney involvement at a large academic medical center. Our novel scoring tools, composite scarring injury score (CSIS) and amyloid score (AS) were applied to each kidney biopsy. The primary outcome was progression to dialysis-dependent end-stage kidney disease (ESKD) using a 12-month landmark analysis. RESULTS At 12 months, nine patients had progressed to ESKD. Patients with an AS ≥7.5 had a significantly higher cumulative incidence of ESKD than those with AS <7.5 (p = .04, 95% CI 0.13-0.64). CONCLUSIONS Using a 12-month landmark analysis, AS correlated with progression to ESKD. These data suggest that a kidney biopsy, in addition to providing diagnostic information, can be the basis for a pathologic scoring system with prognostic significance.
Collapse
Affiliation(s)
- Samuel Rubinstein
- a Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Robert F Cornell
- b Division of Hematology and Oncology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Liping Du
- c Department of Biostatistics , Vanderbilt University , Nashville , TN , USA
| | - Beatrice Concepcion
- d Division of Nephrology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Stacey Goodman
- b Division of Hematology and Oncology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Shelton Harrell
- b Division of Hematology and Oncology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Sara Horst
- e Division of Gastroenterology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Daniel Lenihan
- f Division of Cardiovascular Medicine, Department of Internal Medicine , Vanderbilt Heart and Vascular Institute , Nashville , TN , USA
| | - David Slosky
- g Vanderbilt University Medical Center , Nashville , TN , USA
| | - Agnes Fogo
- h Department of Pathology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Anthony Langone
- d Division of Nephrology, Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| |
Collapse
|
14
|
Kendi Celebi Z, Kiremitci S, Ozturk B, Akturk S, Erdogmus S, Duman N, Ates K, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ensari A, Keven K. Kidney biopsy in AA amyloidosis: impact of histopathology on prognosis. Amyloid 2017; 24:176-182. [PMID: 28686525 DOI: 10.1080/13506129.2017.1350158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In AA amyloidosis, while kidney biopsy is widely considered for diagnosis by clinicians, there is no evidence that the detailed investigation of renal histopathology can be utilized for the prognosis and clinical outcomes. In this study, we aimed to obtain whether histopathologic findings in kidney biopsy of AA amyloidosis might have prognostic and clinical value. This is a retrospective cohort study that included 38 patients who were diagnosed with AA amyloidosis by kidney biopsy between 2005 and 2013.The kidney biopsy specimens of patients were evaluated and graded for several characteristics of histopathological lesions and their relationship with renal outcomes. Segmental amyloid deposition in the kidney biopsy was seen in 29%, global amyloid deposition in 71, diffuse involvement of glomeruli in 84.2%, focal involvement in 7%, glomerular enlargement in 53%, tubular atrophy in 75% and interstitial fibrosis in 78% of patients. Histopathologically, glomerular enlargement, interstitial fibrosis, tubular atrophy, interstitial inflammation and global amyloid deposition were significantly associated with lower estimated glomerular filtration rate (eGFR) (p = .02, p < .001, p = .001, p = .009, p = .002, respectively) in univariate analysis. In multivariate analysis, tubular atrophy was the only predictor of eGFR (p = .019 B = -20.573). In the follow-up at an average of 27 months, 18 patients developed end-stage renal disease (ESRD). Among them, global amyloid deposition was the only risk factor for the development of ESRD (p = .01, OR = 18.750, %95 CI= 2.021-173.942). This is the first study showing that the histopathological findings in kidney biopsy of AA amyloidosis might have a prognostic and clinical value for renal outcomes.
Collapse
Affiliation(s)
- Zeynep Kendi Celebi
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Saba Kiremitci
- b Department of Pathology , Ankara University School of Medicine , Ankara , Turkey
| | - Bengi Ozturk
- c Department of Internal Medicine , Ankara University School of Medicine , Ankara , Turkey
| | - Serkan Akturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Siyar Erdogmus
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Neval Duman
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Ates
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sehsuvar Erturk
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Gokhan Nergizoglu
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sim Kutlay
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Sule Sengul
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| | - Arzu Ensari
- b Department of Pathology , Ankara University School of Medicine , Ankara , Turkey
| | - Kenan Keven
- a Department of Nephrology , Ankara University School of Medicine , Ankara , Turkey
| |
Collapse
|
15
|
|
16
|
Matsuura M, Abe H, Tominaga T, Sakurai A, Murakami T, Kishi S, Bando Y, Minakuchi J, Nagai K, Doi T. A Novel Method of DAPI Staining for Differential Diagnosis of Renal Amyloidosis. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:217-221. [DOI: 10.2152/jmi.64.217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Motokazu Matsuura
- Division of Clinical Laboratory, Tokushima University Hospital
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Hideharu Abe
- Division of Clinical Laboratory, Tokushima University Hospital
| | | | - Akiko Sakurai
- Division of Clinical Laboratory, Tokushima University Hospital
| | - Taichi Murakami
- Division of Clinical Laboratory, Tokushima University Hospital
| | - Seiji Kishi
- Division of Clinical Laboratory, Tokushima University Hospital
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital
| | | | - Kojiro Nagai
- Division of Clinical Laboratory, Tokushima University Hospital
| | - Toshio Doi
- Division of Clinical Laboratory, Tokushima University Hospital
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School
| |
Collapse
|
17
|
Sozeri B, Gulez N, Ergin M, Serdaroglu E. The experience of canakinumab in renal amyloidosis secondary to Familial Mediterranean fever. Mol Cell Pediatr 2016; 3:33. [PMID: 27590627 PMCID: PMC5010548 DOI: 10.1186/s40348-016-0058-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 07/19/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by self-limited recurrent attacks of fever and serositis. Patients may develop renal amyloidosis. Colchicine prevents attacks and renal amyloidosis. Five to 10 % of the patients with FMF are resistant or intolerant to colchicine. CASE DESCRIPTION Herein, we reported our experience with clinical-laboratory features and treatment responses of a pediatric FMF patient with amyloidosis treated with canakinumab. We observed a significant decrease in proteinuria and increase growth in the patient. DISCUSSION AND EVALUATION The most serious complication of FMF is the development of AA type amyloidosis which is characterized by proteinuria. Colchicine is the prototype drug that decreases production of amyloidogenic precursor protein. Occasionally, colchicine inadequate patient is observed, as in our case. Canakinumab is a human anti-IL-1β monoclonal antibody. Previously, canakinumab efficacy were shown in a limited number of studies. CONCLUSIONS Our data, though limited to only one patient, emphasize that therapeutic intervention with canakinumab seems to be improve kidney function in colchicine-resistant FMF with renal amyloidosis.
Collapse
Affiliation(s)
- Betul Sozeri
- Department of Pediatric Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Nesrin Gulez
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pediatric Immunology and Rheumatology, Izmir, Turkey
| | - Malik Ergin
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pathology, Izmir, Turkey
| | - Erkin Serdaroglu
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pediatric Nephrology, Izmir, Turkey
| |
Collapse
|
18
|
Topaloglu R, Batu ED, Orhan D, Ozen S, Besbas N. Anti-interleukin 1 treatment in secondary amyloidosis associated with autoinflammatory diseases. Pediatr Nephrol 2016; 31:633-40. [PMID: 26563115 DOI: 10.1007/s00467-015-3249-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amyloidosis may complicate autoinflammatory diseases (AID). We aimed to evaluate the renal biopsy findings, and clinical and laboratory parameters in patients with AID-associated amyloidosis who have responded to anti-interleukin 1(IL1) treatment. METHODS Two children with systemic juvenile idiopathic arthritis and one with cryopyrin-associated periodic syndrome diagnosed as having reactive amyloidosis were treated with anti-IL1 drugs. The renal histopathological findings at the time of diagnosis of amyloidosis and after the onset of anti-IL1 were evaluated according to the amyloid scoring/grading system. RESULTS The median age of disease onset and diagnosis of amyloidosis were 3 and 12 years, respectively. Anakinra was started in all; however, anakinra caused a local cutaneous reaction in one, thus canakinumab was commenced. Proteinuria improved in all. Control renal biopsies were performed a median of 3 years after the first biopsies. The renal amyloid prognostic score did not improve in patient 1, and progressed in patients 2 and 3. The renal amyloid grade progressed in patient 2. CONCLUSIONS This is the first series demonstrating progression of renal tissue damage after the improvement of proteinuria with anti-IL 1 in AID-associated amyloidosis. Anti-IL1 drugs are important to prevent further amyloid accumulation; however, new treatment strategies are needed to target the amyloid deposits.
Collapse
Affiliation(s)
- Rezan Topaloglu
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey.
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatrics, Division of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nesrin Besbas
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| |
Collapse
|
19
|
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.
Collapse
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.
| |
Collapse
|
20
|
Serum galectin-3 levels were associated with proteinuria in patients with Familial Mediterranean Fever. Clin Exp Nephrol 2014; 19:436-42. [DOI: 10.1007/s10157-014-1009-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
|
21
|
Olsson M, Tintle L, Kierczak M, Perloski M, Tonomura N, Lundquist A, Murén E, Fels M, Tengvall K, Pielberg G, Dufaure de Citres C, Dorso L, Abadie J, Hanson J, Thomas A, Leegwater P, Hedhammar Å, Lindblad-Toh K, Meadows JRS. Thorough investigation of a canine autoinflammatory disease (AID) confirms one main risk locus and suggests a modifier locus for amyloidosis. PLoS One 2013; 8:e75242. [PMID: 24130694 PMCID: PMC3793984 DOI: 10.1371/journal.pone.0075242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/13/2013] [Indexed: 12/04/2022] Open
Abstract
Autoinflammatory disease (AID) manifests from the dysregulation of the innate immune system and is characterised by systemic and persistent inflammation. Clinical heterogeneity leads to patients presenting with one or a spectrum of phenotypic signs, leading to difficult diagnoses in the absence of a clear genetic cause. We used separate genome-wide SNP analyses to investigate five signs of AID (recurrent fever, arthritis, breed specific secondary dermatitis, otitis and systemic reactive amyloidosis) in a canine comparative model, the pure bred Chinese Shar-Pei. Analysis of 255 DNA samples revealed a shared locus on chromosome 13 spanning two peaks of association. A three-marker haplotype based on the most significant SNP (p<2.6×10−8) from each analysis showed that one haplotypic pair (H13-11) was present in the majority of AID individuals, implicating this as a shared risk factor for all phenotypes. We also noted that a genetic signature (FST) distinguishing the phenotypic extremes of the breed specific Chinese Shar-Pei thick and wrinkled skin, flanked the chromosome 13 AID locus; suggesting that breed development and differentiation has played a parallel role in the genetics of breed fitness. Intriguingly, a potential modifier locus for amyloidosis was revealed on chromosome 14, and an investigation of candidate genes from both this and the chromosome 13 regions revealed significant (p<0.05) renal differential expression in four genes previously implicated in kidney or immune health (AOAH, ELMO1, HAS2 and IL6). These results illustrate that phenotypic heterogeneity need not be a reflection of genetic heterogeneity, and that genetic modifiers of disease could be masked if syndromes were not first considered as individual clinical signs and then as a sum of their component parts.
Collapse
Affiliation(s)
- Mia Olsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- * E-mail: (MO); (KL-T); (JRSM)
| | - Linda Tintle
- Wurtsboro Veterinary Clinic, Wurtsboro, New York, United States of America
| | - Marcin Kierczak
- Computational Genetics Section, Department of Clinical Sciences, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Michele Perloski
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
| | - Noriko Tonomura
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, United States of America
| | - Andrew Lundquist
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
| | - Eva Murén
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Max Fels
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Katarina Tengvall
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Gerli Pielberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | | | - Laetitia Dorso
- LUNAM University, Oniris, AMaROC Unit, Nantes, F-44307, France
| | - Jérôme Abadie
- LUNAM University, Oniris, AMaROC Unit, Nantes, F-44307, France
| | - Jeanette Hanson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Anne Thomas
- ANTAGENE Animal Genetics Laboratory, La Tour de Salvagny (69 Lyon), France
| | - Peter Leegwater
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Åke Hedhammar
- Department of Clinical Sciences, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
- * E-mail: (MO); (KL-T); (JRSM)
| | - Jennifer R. S. Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- * E-mail: (MO); (KL-T); (JRSM)
| |
Collapse
|
22
|
Kuroda T, Tanabe N, Sato H, Nakatsue T, Wada Y, Murakami S, Nakano M, Narita I. Distribution of amyloid deposits in the kidneys of a patient with reactive amyloidosis associated with rheumatoid arthritis. BMC Res Notes 2013; 6:231. [PMID: 23763756 PMCID: PMC3693877 DOI: 10.1186/1756-0500-6-231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/12/2013] [Indexed: 11/22/2022] Open
Abstract
Background We previously reported that the amount of amyloid A (AA) amyloid deposited in renal biopsy specimens was highly correlated with parameters of renal function. However, the distribution of amyloid deposits throughout the kidneys of these patients, and the degree of renal abnormality, remained unclear. Therefore, we describe the features of reactive amyloidosis associated with rheumatoid arthritis (RA) in an autopsied patient. Case presentation The present report case is a 50-year-old female with RA and reactive amyloidosis. She was diagnosed as RA in 1978. Diagnosis of AA amylodosis was made by renal biopsy in 1991 for the reason of proteinuria. Because of the pancreatitis, she was died in 2006 and autopsy was performed. Renal tissues from autopsy specimens were evaluated for their proportions of amyloid-positive areas. A total of 6 specimens (three tissue blocks from each kidney obtained at autopsy) were evaluated in this study. The size of each block was approximately 20 mm × 20 mm. One section of whole tissue was photographed in each case. The borders of the amyloid-positive areas in each specimen were traced in each photograph, excluding any tissue-free spaces. The total amyloid-positive area was measured, and the percentage area of amyloid per whole-tissue section (percent (%) area of amyloid deposition) was calculated. The distribution of amyloid deposits in the kidneys was examined. The significance of differences in the mean percent (%) area of amyloid deposition between the right and left sides and among three long-axis levels (upper, middle and lower) were analyzed by two-way analysis of variance (ANOVA) at a significance level of p <0.05. Conclusion The area of amyloid deposition in these samples was about 7-11%, and the degree of variability among them seemed to be small. It also shows a comparison of amyloid deposition between the right and left sides and between the long axis samples for quadruplicate determinations; no significant differences were evident, and thus the percent (%) area of amyloid deposition throughout the whole kidneys appeared to be uniform in this patient.
Collapse
Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata City 951-8510, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Sarsik B, Sen S, Kirdok FS, Akarca US, Toz H, Yilmaz F. Hepatic amyloidosis: Morphologic spectrum of histopathological changes in AA and nonAA amyloidosis. Pathol Res Pract 2012; 208:713-8. [DOI: 10.1016/j.prp.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
|
24
|
Yao Y, Wang SX, Zhang YK, Qu Z, Liu G, Zou WZ. A clinicopathological analysis in a large cohort of Chinese patients with renal amyloid light-chain amyloidosis. Nephrol Dial Transplant 2012. [PMID: 23182813 DOI: 10.1093/ndt/gfs501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of the study is to investigate the association between clinical and pathological features in a large cohort of Chinese patients with renal immunoglobulin light-chain amyloidosis (AL). METHODS A series of 186 patients with renal AL amyloidosis diagnosed between 1990 and 2011 were retrospectively reviewed. The extent of amyloid deposition in glomeruli, blood vessels and tubulointerstitium were evaluated semiquantitatively. The renal amyloid load was defined by the sum of glomerular, vascular and interstitial deposits. The associations between the clinical manifestations and pathological features were analyzed. RESULTS The extent of glomerular amyloid deposition was positively correlated with the level of proteinuria. Patients with codeposition of amyloid and immune complexes (ICs) in glomeruli had higher levels of proteinuria than those without ICs. Advanced glomerular amyloid deposition was an independent pathological factor associated with renal insufficiency at diagnosis. The degree of vascular amyloid (VA) deposition was positively correlated with cardiac involvement and hepatic involvement. Patients with AL-κ showed a higher prevalence of hepatic involvement and more severe VA deposition than patients with AL-λ. High renal amyloid load independently predicted the increased risk for overall death after adjusting for recognized confounders. CONCLUSIONS The degree and localization of amyloid deposits in the kidney of AL patients were associated with the degree of proteinuria and renal insufficiency, as well as extrarenal organs involvement. There were some differences between AL-κ and AL -λ in clinical and pathological characteristics. The renal amyloid load was an independent predictor for overall mortality.
Collapse
Affiliation(s)
- Ying Yao
- Department of Medicine, Peking University FirstHospital, Beijing, China
| | | | | | | | | | | |
Collapse
|
25
|
Sarsık B, Simşir A, Yılmaz M, Yörükoğlu K, Sen S. Spectrum of nontumoral renal pathologies in tumor nephrectomies: nontumoral renal parenchyma changes. Ann Diagn Pathol 2012; 17:176-82. [PMID: 23142019 DOI: 10.1016/j.anndiagpath.2012.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/09/2012] [Indexed: 11/24/2022]
Abstract
Non-neoplastic changes are not rarely seen in renal parenchyma of nephrectomy specimens removed for primary renal neoplasms. These changes often involve both kidneys, thus causing impairment of renal function, reducing patient's quality of life and sometimes threatening it. Renal tissue accompanying the tumor provides an opportunity in order to evaluate these changes. However, the clinician should make available clinical and laboratory findings involving renal functions of the patient to the pathologist. It is also important that the pathologist must have appropriate knowledge and experience in nephropathology. In this study, we aimed to correlate these changes with the clinical data and make inquiries regarding our experience with nonneoplastic kidney pathology. Consecutive 403 nephrectomy specimens with primary renal neoplasms submitted to our department between 2003 and 2009 were re-examined. Twenty-three nephrectomy materials from 21 patients had non-neoplastic changes, 2 of which were bilateral. Patient follow-up data were obtained from electronic medical records. Of all cases, eight had diabetic nephropathy; 2, amyloidosis; 5, segmental proliferative and/or sclerotic glomerulonephritis; and 6, cystic renal changes. These findings were seen in 5% of nephrectomy specimens diagnosed as clear cell renal cell carcinoma (RCC), chromophobe cell RCC and oncocytoma, whereas this rate was two times higher in nephrectomy specimens with papillary RCC. Most patients with renal failure who were diagnosed with clear cell carcinoma died within the first two years. Despite limited number of cases in our series, prognosis of cases with clear cell RCC were poorer. Consequently, we think that non-neoplastic changes should be reported along with the details regarding the tumor in order to achieve best treatment planning.
Collapse
Affiliation(s)
- Banu Sarsık
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey.
| | | | | | | | | |
Collapse
|
26
|
Kuroda T, Tanabe N, Kobayashi D, Wada Y, Murakami S, Nakano M, Narita I. Significant association between renal function and amyloid-positive area in renal biopsy specimens in AL amyloidosis. BMC Nephrol 2012; 13:118. [PMID: 23006903 PMCID: PMC3515801 DOI: 10.1186/1471-2369-13-118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background The kidney is a major target organ for systemic amyloidosis that often affects the kidney including proteinura, and elevated serum creatinine (Cr). The correlation between amount of amyloid deposits and clinical parameters is not known. The aim of this study was to clarify correlation the amyloid area in all renal biopsy specimen and clinical parameters. Methods Fifty-eight patients with an established diagnosis of AL amyloidosis participated in the study. All patients showed amyloid deposits in renal biopsies. We retrospectively investigated the correlation between clinical data and amyloid occupied area in whole renal biopsy specimens. Results The area occupied by amyloid was less than 10% in 57 of the 58 patients, and was under 2% in 40. For statistical analyses, %amyloid-positive areas were transformed to common logarithmic values (Log10%amyloid). Cr showed significant correlation with Log10%amyloid and estimated glomerular filtration rate (eGFR) showed the significant negative correlation. Patient age, cleatinine clearance (Ccr), blood urea nitorogen, and urinary protein was not significantly correlated with Log10%amyloid. The correlation with other clinical factors such as sex, and serum concentrations of total protein, albumin, immunoglobulins, compliments was evaluated. None of these factors significantly correlated with Log10%amyloid. According to sex- and age- adjusted multiple linear regression analysis, Log10%amyloid had significant positive association with Cr and significant negative association with eGFR. Conclusion There is significant association between amyloid-positive area in renal tissue and renal function, especially Cr and eGFR. The level of Cr and eGFR may be a marker of amount of amyloid in renal tissue.
Collapse
Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
A 28-year-old women is presented who was evaluated for a new-onset postpartum nephrotic syndrome with normal renal function. Histological diagnosis was AA amyloidosis but no underlying disease has been diagnosed despite extensive workup. Complete remission was achieved with colchicine. Upon discontinuation of colchicines, the patient's nephrotic syndrome flared up but completely responded to reinstitution of colchicine therapy. Remission of this patient's nephrotic syndrome is thus not attributable to resolution of any "idiopathic" primary disease.
Collapse
Affiliation(s)
- Michael J Hausmann
- Department of Nephrology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Hopfer H, Wiech T, Mihatsch MJ. Renal amyloidosis revisited: amyloid distribution, dynamics and biochemical type. Nephrol Dial Transplant 2011; 26:2877-84. [PMID: 21427073 DOI: 10.1093/ndt/gfq831] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Renal amyloidosis results from protein misfolding and leads to progressive renal insufficiency. Few data are available concerning the relevance of the histomorphological patterns and the dynamics of the disease process. METHODS Cases of renal amyloidosis in native kidney biopsies (n = 203) were retrospectively evaluated for the pattern of amyloid distribution, the extent of glomerular amyloid deposition and the amount of interstitial fibrosis and tubular atrophy. One hundred and fifty-eight cases were characterized by immunohistochemistry to determine the biochemical amyloid type. Morphological findings were correlated with available clinical data. RESULTS According to the predominant site of amyloid deposition, 84.6% showed a glomerular, 9.4% a vascular and 6% a tubulointerstitial distribution pattern. Within the glomeruli, amyloid was initially deposited in a focal segmental fashion that became diffuse and global in later stages. Most cases were identified as AL lambda (84/158) or AA (68/158). There was no correlation between the biochemical type and the distribution pattern. Serum creatinine correlated well with interstitial fibrosis and tubular atrophy and proteinuria with the glomerular amyloid load. CONCLUSIONS The relevance of the different distribution patterns is unclear at the moment, but they may be due to the physicochemical properties of the amyloid fibrils in a given patient. This may become important in future anti-fibrillar therapies.
Collapse
Affiliation(s)
- Helmut Hopfer
- Pathology, University Hospital Basel, Basel, Switzerland.
| | | | | |
Collapse
|
30
|
Verine J. A proposed histopathologic classification, scoring, and grading system for renal amyloidosis. Arch Pathol Lab Med 2011; 135:168; author reply 168-9. [PMID: 21284429 DOI: 10.5858/135.2.168.a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
31
|
Şen S, Sarsik B. In Reply. Arch Pathol Lab Med 2011. [DOI: 10.5858/135.2.168.b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sait Şen
- Department of Pathology, Ege University School of Medicine, Bornova İzmir, Turkey
| | - Banu Sarsik
- Department of Pathology, Ege University School of Medicine, Bornova İzmir, Turkey
| |
Collapse
|
32
|
Fukuda K, Kaneko T, Utsumi K, Tamura H, Shimizu A, Iino Y, Katayama Y. Clinical Features of AL Amyloidosis Diagnosed via Renal Biopsy, and Response to Treatment. J NIPPON MED SCH 2010. [DOI: 10.1272/jnms.77.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kumiko Fukuda
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School
| | - Tomohiro Kaneko
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School
| | - Koichi Utsumi
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School
| | - Hideto Tamura
- Divisions of Hematology, Department of Internal Medicine, Nippon Medical School
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School
| | - Yasuhiko Iino
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School
| | - Yasuo Katayama
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School
| |
Collapse
|