Generalized Aggressive Periodontitis in a Patient With Nephrotic Syndrome Associated With Primary Renal Amyloidosis: A Case Report

Abstract

Introduction: Renal amyloidosis may lead to renal disease, and then nephrotic syndrome may develop. To the best of the authors’ knowledge, this is the first case report in which a patient presents with generalized aggressive periodontitis (GAgP) and nephrotic syndrome in conjunction with renal amyloidosis. Case Presentation: An 18‐year‐old male presented to the periodontology department for generalized gingival recessions. He was diagnosed as having primary renal amyloidosis by his physician. The patient presented with severe gingival inflammation and alveolar bone loss. Biochemical tests were within normal limits except for serum albumin level. No amyloid deposition was found in a gingival biopsy, and the patient was diagnosed as having GAgP. Non‐surgical periodontal treatment, in combination with antibiotic treatment, was performed. After 3 years, his systemic and periodontal conditions showed deterioration. Conclusions: The effects of systemic factors related to nephrotic syndrome in conjunction with renal amyloidosis and deterioration in oral hygiene may play a significant role in the progression of periodontal disease. Even if there is no amyloid deposition in periodontal tissues, clinicians should consider that nephrotic syndrome associated with systemic amyloidosis may provide an important contribution to the periodontal breakdown by the modifying conditions that affect the host response to the accumulation of dental biofilm.

Serum, salivary, and tissue levels of plasminogen in familial Mediterranean fever, amyloidosis, and chronic periodontitis

“…To our knowledge, this is the first comprehensive cross‐sectional study to evaluate patients with chronic periodontitis and FMF‐associated systemic secondary amyloidosis. Only a case report of primary renal amyloidosis, FMF (E148Q heterozygous), and generalized aggressive periodontitis have been reported by our colleagues . In that case report, the patient presented with accelerated periodontal breakdown without gingival amyloidosis.…”

“…In that case report, the patient presented with accelerated periodontal breakdown without gingival amyloidosis. Clinicians should consider that amyloidosis can increase the destruction of periodontal tissues, even if there is no amyloid deposition in the periodontium . It has been suggested that the prevalence of amyloid‐associated (AA) amyloidosis is higher than that of amyloid‐like (AL) amyloidosis in developing countries because of the higher prevalence of associated underlying infectious diseases .…”

“…Genetic and inflammatory mechanisms have been used to clarify the association between periodontal disease and systemic disease . However, the periodontal data of patients with FMF and/or amyloidosis are limited to only case reports . Furthermore, it is noteworthy that 60% of patients with LP and low PLG activity are Turkish …”

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever

“…It has also been previously shown that the prevalence of moderate to severe periodontitis is significantly higher in patients with FMF and amyloidosis than in those with FMF without amyloidosis . A case report (by our colleagues firstly) declared a patient with generalized aggressive periodontitis with systemic renal amyloidosis who was an E148Q heterozygote . In that report, the patient presented with accelerated periodontal breakdown without gingival amyloidosis.…”

“…In that report, the patient presented with accelerated periodontal breakdown without gingival amyloidosis. This case emphasizes that clinicians should consider that amyloidosis can increase destruction of periodontal tissues even if there is no amyloid deposition in the periodontium . SAA is the amyloid fiber precursor protein in patients with secondary systemic AA amyloidosis and may be a robust inflammatory factor that modifies the host response to bacterial challenge .…”