AA renal amyloidosis: Clinical observations over 20 years

Khellaf, G.; Benziane, A.; Kaci, L.; Benabadji, M.

doi:10.5414/cn110577

Cited by 5 publications

(2 citation statements)

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“…3 Any chronic inflammation causing a persistent increase in SAA concentration can be complicated by AA amyloidosis. Infectious diseases are more common in low-income countries, 4,5 whereas in more developed countries, rheumatologic diseases used to be the leading cause of AA amyloidosis before the advent of effective biological therapies. 6 Currently, autoinflammatory diseases, certain types of cancer, and obesity are emerging conditions underlying AA amyloidosis.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of Staging Systems for AA Amyloidosis

Basset,

Schönland,

Obici

et al. 2024

JASN

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Background: The kidney is involved in almost 100% of cases of AA amyloidosis, a rare disease caused by persistent inflammation with long overall survival but frequent progression to end-stage kidney failure . Identification of patients with advanced disease at diagnosis is difficult, given the absence of validated staging systems. Methods: Newly diagnosed patients with AA amyloidosis from the Pavia (n=233, testing cohort) and Heidelberg (n=243, validation cohort) centers were included in the study. Cut-offs of continuous variables were determined by ROC analysis predicting death or dialysis at 24 months. Prognostic factors included in staging systems were identified by multivariable models in the testing cohort. Results: Age ≥65 years, estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m2 and elevated natriuretic peptides (type-B natriuretic peptide [BNP] >130 ng/L and/or N-terminal BNP [NT-proBNP] >1000 ng/L) were predictors of overall survival and included in the staging system (all with simplified coefficients 1). Mean 36-months overall survival was lower with higher staging system scores (score 0-1: 92%; score 2: 72%; score 3: 32%). These results were confirmed in the validation cohort. For kidney failure, variables selected to enter in the staging system model were proteinuria >3 g/24h and eGFR <35 mL/min/1.73m2 (both with simplified coefficients 1). The 36-month cumulative incidence of kidney failure was higher with higher staging system scores (score 0: 0%; score 1: 24%; score 2: 51%). Again, similar results were obtained in validation cohort. Conclusions: We identified and validated biomarker-based staging systems for overall survival and kidney failure in AA amyloidosis.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of Staging Systems for AA Amyloidosis

Basset,

Schönland,

Obici

et al. 2024

JASN

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“…При многих из них почечный процесс является проявлением основного заболевания, в частности при АНЦА (антитела к цитоплазме нейтрофилов)-ассоциированных васкулитах (ААВ) вовлечение почек наблюдают в зависимости от нозологической формы заболевания у 22,7-96,9% пациентов, при системной красной волчанке (СКВ) в 7-31% случаев болезнь манифестирует с поражения почек, у 31-48% пациентов нефрит развивается в течение первых 5 лет после установки диагноза [3,4]. Частым осложнением плохо контролируемых воспалительных заболеваний суставов является АА-амилоидоз [5]. Кроме того, вклад в поражение почек могут вносить применение некоторых лекарственных препаратов (ингибиторов кальциневрина, нестероидных противовоспалитель-ных препаратов) и развитие инфекций на фоне длительной иммуносупрессивной терапии.…”

Section: Introductionunclassified

Impact of kidney biopsy on the management of patients in the rheumatology department: retrospective study

Kokhanchuk

Skvortsov

Shchegoleva

et al. 2022

Terapevticheskii arkhiv

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Background. Kidney involvement is a common manifestation of the systemic autoimmune rheumatic diseases. Kidney biopsy is the gold standard for the diagnosis of kidney diseases, however this method has not yet become the standard-of-care in rheumatology practice. Aim. To assess the diagnostic value of kidney biopsy in the management of patients of the rheumatology department. Materials and methods. In this retrospective observational study we analyzed the medical documentation including kidney morphology findings in the patients of the Department of Rheumatology at Tareev Clinic of Internal Diseases. All patients included in the research had signs of kidney involvement and had undergone needle biopsy of the kidney or re-evaluation of the kidney tissue received previously. Results. From June 2016 to October 2021, 3110 patients were admitted to the rheumatology department. Among them 63 (2%) underwent kidney biopsy and were included in the study. Twenty (32%) were male. Mean age was 42.513.9 years. The most common preliminary diagnoses before kidney biopsy were ANCA-associated vasculitis (n=17), systemic lupus erythematosus (n=12), and AA-amyloidosis associated with inflammatory joint diseases (n=7). In 14 (27%) patients diagnosis was unspecified at the time of biopsy. Among 49 patients with established preliminary diagnosis morphological findings were in line 38 (78%) with the pre-liminary diagnosis. However, in 11 (22%) patients morphological findings resulted in the change of the diagnosis. In all 14 patients with unspecified condition kidney biopsy helped to establish clinical diagnosis. Ultrasound evaluation demonstrated hematoma formation in 18 (31%) patients, and among them two required blood component transfusions. Conclusion. Our study demonstrates significant value and safety of kidney biopsy in the patients with autoimmune rheumatic conditions. We suggest that kidney biopsy should be implemented in the management of this category of patients.

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