Protein‐losing enteropathy due to secondary amyloidosis of the gastrointestinal tract

Kikuchi, Makoto; Koizumi, Fumitomo; Shimao, M; Hirose, Shoichiro

doi:10.1111/j.1440-1827.1993.tb02576.x

Cited by 8 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypoalbuminemia from gastrointestinal losses has even been described as the presenting symptom of SLE [88]. Protein-losing enteropathy can also occur in patients with secondary amyloidosis [89] and the acquired immune deficiency syndrome [90]. The presence of copious diarrhea and a serum albumin concentration lower than anticipated for the degree of albuminuria should raise the suspicion of a protein-losing enteropathy.…”

Section: Protein-losing Enteropathy: Another Potential Site Of Albumimentioning

confidence: 99%

Albumin Turnover in Renal Disease

Kaysen

1997

Mineral Electrolyte Metab

View full text Add to dashboard Cite

Hypoalbuminemia is found in patients both with the nephrotic syndrome and with end-stage renal disease (ESRD) treated either with continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis. In nephrotic patients the primary causes of hypoalbuminemia are urinary albumin losses, an inappropriate increase in the fractional catabolic rate (FCR) of albumin and an insufficient increase in the rate of albumin synthesis to replace these losses. Nevertheless, the albumin synthetic rate is increased significantly. In patients on CAPD, albumin losses into the urine and across the peritoneal membrane contribute significantly to hypoalbuminemia. In contrast to nephrotic patients, albumin FCR decreases as serum albumin falls and serum albumin levels are significantly greater than in nephrotic patients with the same external losses of albumin. CAPD patients, like nephrotic patients with normal renal function, can increase albumin synthesis to replace losses. Thus ESRD does not directly suppress albumin synthesis. In contrast, hypoalbuminemia in hemodialysis patients results from reduced albumin synthesis. The cause of decreased albumin synthesis is a combination of response to inflammation (acute-phase response) and, to a lesser extent, inadequate nutrition. There is no evidence that shifts of albumin to the extravascular space or that dilution of the plasma by volume expansion play any role in causing hypoalbuminemia in ESRD or nephrotic patients.

show abstract

Section: Protein-losing Enteropathy: Another Potential Site Of Albumimentioning

confidence: 99%

Albumin Turnover in Renal Disease

Kaysen

1997

Mineral Electrolyte Metab

View full text Add to dashboard Cite

show abstract

“…During the course of diarrhoea, all cases showed severe hypoproteinaemia and hypoalbuminaemia.These results suggested malabsorption 22 or protein loss 14. Moreover, highly increased values of C reactive protein during the clinical course were pathognomonic of intractable diarrhoea.…”

Section: Discussionmentioning

confidence: 88%

Intractable diarrhoea associated with secondary amyloidosis in rheumatoid arthritis

Okuda

Takamatsu

Oyama

et al. 1997

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

Objective-To examine the clinical characteristics of intractable diarrhoea associated with secondary amyloidosis in rheumatoid arthritis (RA). Methods-Of 179 RA patients with biopsy confirmed secondary amyloidosis, 24 cases (23 women and one man) with intractable diarrhoea lasting for more than one month were retrospectively evaluated. Results-The mean (SD) duration of diarrhoea was 87 (64) days. Prodromal symptoms of gastrointestinal dysfunction (n = 21) and impaired peristalsis (n = 16) were observed. Laboratory data showed hypoproteinaemia (4.7 (0.85) g/dl) caused by malabsorption or protein loss and high values of C reactive protein (17.0 (9.3) mg/dl). Recurrence of intractable diarrhoea (n = 4) and transition from intractable diarrhoea to other gastrointestinal problems of amyloidosis (ischaemic colitis (n = 2) and intestinal pseudoobstruction (n = 4)) were observed. In 19 patients (25 episodes) the duration of intravenous hyperalimentation at remission (18 episodes) was 68 (52) days. Corticosteroid pulse therapy was administered to 10 patients (11 times) and the time elapsed from the end of corticosteroid pulse therapy to the end of diarrhoea was 18 (14) days. One and five year survival rates after the onset of intractable diarrhoea were 73.4% and 38.9% . Seven of 13 patients (54%) had died as a result of infectious diseases. Conclusion-Intractable diarrhoea associated with secondary amyloidosis in RA is a serious clinical entity and the prognosis is poor. Although it is assumed that intravenous hyperalimentation treatment and corticosteroid pulse therapy are favourable regimens for intractable diarrhoea, the patients should be monitored for possible infectious complications.

show abstract

“…Enteropathy protein-losing is related to an increased capillary permeability to plasma proteins, to exudation trough an inflamed mucosa and, also, to the functional disruption of the lymphatic flow in the bowel and mesenterium [7].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Amyloidosis: An Unusual Case Where Protein-Losing Enteropathy is Associated to Malabsorption

Tirotta¹,

Durante²

2016

Arch Clin Gastroenterol

View full text Add to dashboard Cite

Introduction: The systemic amyloidosis usually doesn't save the digestive tract, but this involvement is present in approximately 60% of patients with AA Amyloidosis and only in 8% and 1% of patients with AL Amyloidosis (respectively through biopsy and clinically). Beside gastrointestinal involvement is rarely symptomatic and clinical events are not specific. Enteropathy protein-losing is a rare condition caused by excessive loss of serum protein in the gastrointestinal tract, resulting in hypoproteinaemia, edema, and, sometimes, pleural/pericardial effusions. The diagnosis should be taken into account only when other causes have been excluded. Gastrointestinal AL amyloidosis usually appears with constipation and mechanical obstruction/ pseudobstruction, on the contrary enteropathy protein-losing and malabsorption are rare. Case report: We report the case of a 59-year-old patient, with AL amyloidosis, who suffered from weight loss and ascites effusion related to an AL amyloidosis. Discussion: The case is unusual, both because of the extension in the gastrointestinal tract and for its unusual clinical presentation as enteropathy protein-losing associated with malabsorption.

show abstract

Protein‐losing enteropathy due to secondary amyloidosis of the gastrointestinal tract

Cited by 8 publications

References 10 publications

Albumin Turnover in Renal Disease

Albumin Turnover in Renal Disease

Intractable diarrhoea associated with secondary amyloidosis in rheumatoid arthritis

Gastrointestinal Amyloidosis: An Unusual Case Where Protein-Losing Enteropathy is Associated to Malabsorption

Contact Info

Product

Resources

About