Colchicine use in isolated renal AA amyloidosis

Abstract

a b s t r a c tWe present the case of a 45-year-old woman, with two-year history of chronic renal insufficiency and proteinuria. A kidney biopsy showed the presence of AA amyloidosis (positive Congo red staining and immunohistochemistry). There was no evidence of amyloid deposits in other organs and there was no underlying disease. AA amyloidosis normally is secondary to chronic inflammatory or infectious diseases. High levels of IL-1, IL-6 and TNF-␣ play a role in the pathogenesis of amyloidosis and induce the synthesis of serum amyloid A protein (SAA), a precursor of tissue amyloid deposits. We empirically treated the patient with a low dose colchicine. The patient responded well. Colchicine has been used for the treatment of Familiar Mediterranean Fever and related auto-inflammatory diseases. To monitor treatment responses, we measured SAA finding low titers. Soon after treatment onset there were signs of improvement pertaining to proteinuria and stabilization of renal function.

The Case of a Mother Who Was Also Diagnosed with Familial Mediterranean Fever Following Her Children’s Diagnoses

“…But no connection has been demonstrated between the occurrence of amyloidosis and FMF starting age, frequency of attacks, and duration [6]. Colchicine treatment plays a significant role in preventing amyloidosis development [7]. Anakinra, rilonacept, canakinumab, and tocilizumab are recommended in the 5-10% of patients resistant to colchicine [8].…”

Colchicine in Renal Medicine: New Virtues of an Ancient Friend

“…When started early and used at sufficient doses with a good compliance, development of AA amyloidosis can effectively be prevented in these patients [78] . Established AA renal amyloidosis is much less responsive to colchicine treatment [79] .…”