Successful Use of Maintenance Infliximab for Nephropathy in a Patient with Secondary Amyloidosis Complicating Crohn's Disease

Abstract

Systemic AA amyloidosis is a complication of various inflammatory diseases including Crohn's disease (CD). Amyloid nephropathy is the most common clinical presentation of AA amyloidosis leading to renal failure, and affected patients often require hemodialysis and ultimately renal transplantation. We herein report the successful use of infliximab as maintenance therapy for amyloid nephropathy in a patient with CD. In the present patient, surgical treatment and infliximab infusion immediately induced a remission of CD, and scheduled infliximab therapy successfully maintained the patient's stable condition for three years, with a significant decrease in the serum creatinine level.

Therapeutic effects of biological treatments on AA amyloidosis associated with inflammatory bowel disease: a case report and literature review

“…Unfortunately, there is no identifiable endoscopic appearance of gastrointestinal amyloidosis, it is either a normal appearance, an indistinct vascular pattern, redness, or edema. Furthermore, the involvement of the gastrointestinal tract is segmental or patchy [14,44], and the sensitivity of amyloid detection varies depending on location; while the kidney has the maximum sensitivity, rectum biopsies have a low sensitivity [5,14,45,46], and this was consistent with our results as many patients had positive renal biopsies, while other biopsies sites were negative [3,23,26,31,37]. Congo red is the standard tool for detecting amyloid in tissues, despite its low sensitivity, as it is technically challenging, resulting in irregular staining.…”

“…Infliximab was the first drug for IBD, so it is natural that it is the most widely used drug [50]. In the majority of cases, infliximab was able to improve proteinuria or renal function [3,22,24,25,27–29,31,34,36,37]; additionally, infliximab contributed to patient stability and prevented the progression of proteinuria or renal injury [3,23,30,34,35]; Unfortunately, infliximab failed in a number of cases, which either led to the progression of proteinuria or renal function [3,26,32,34,36,38]. Although infliximab therapeutic drug monitoring is more effective in maintaining disease control [51].…”

Amyloid Proteins and Peripheral Neuropathy

“…In psoriatic arthritis, amyloid has been reported in 30 cases and was present mainly in the kidney [ 166 ]. In Crohn’s disease, SAA-protein-derived amyloid is found in the kidney and gastrointestinal tract in 0.3–10% of patients [ 167 , 168 , 169 ].…”

Research update for articles published inEJCIin 2013

“…The conclusions that vigorous treatment including anti-tumour necrosis factor (TNF)-a agents of Crohn's disease (CD) complicated by AA amyloidosis, reduce amyloid A production, were confirmed [22][23][24]. Long survival after kidney transplantation for end-stage renal disease was also confirmed [24].…”