Prognosis of Renal Amyloidosis: A Clinicopathological Study Using Cluster Analysis

Abstract

Progression of renal amyloidosis is associated with severe proteinuria or nephrotic syndrome, and various mechanisms have been postulated to explain these complications. We studied the acceleration of proteinuria and reduced renal function by cluster analysis using clinical parameters, renal histological findings, type of renal amyloidosis and follow-up data. We divided 97 cases into three groups of renal amyloidosis. Accelerated progression correlated with serum creatinine (s-Cr) levels at renal biopsy and histological grade of renal damage by amyloid deposition (p < 0.0001). The most influential prognostic factors (s-Cr level ≧2.0 mg/dl) were tubulointerstitial and vascular damage induced by amyloid deposition at biopsy (odds ratio 96.9 and 69.2, respectively). In addition, we found amyloidosis type amyloid associated (AA) correlated with more amyloid-mediated vascular and tubulointerstitial damage than amyloidosis type amyloid light chain (AL) (p < 0.001, p < 0.01, respectively). Proteinuria and nephrotic syndrome were more severe in cases of amyloidosis AL than in amyloidosis AA (p = 0.076). In conclusion, less tubulointerstitial and vascular damage was caused by amyloid deposition; this was slowly progressive. Amyloid AA was detected in tubulointerstitial tissue and vessels more frequently than amyloid AL. Heavy proteinuria and/or nephrosis were not indicators of rapid progression.

Renal Involvement in AA Amyloidosis: Clinical Outcomes and Survival

“…Gertz et al [11] analyzed 64 patients with AA amyloidosis and demonstrated that renal dysfunction (serum creatinine value of > 2 mg/dl) at presentation is strongly associated with shorter survival. Other studies confirmed that serum creatinine concentration is an important predictive factor for the survival of AA amyloidosis patients, as well [16,18]. In the present study, a finding deserves special mention: although low serum albumin was the strongest predictor of death, proteinuria did not show this significance.…”

Chronic renal failure due to amyloid nephropathy caused by chronic infection after total hip replacement

“…The farming accident may have promoted this condition. AA amyloidosis induces more extensive amyloid deposits on the tubular basement membrane, interstitial tissue, and arteriolar walls of the kidneys and rapidly worsens the prognosis of patients compared to AL amyloidosis [13]. In our case, amyloid deposition on the tubular basement membrane and arteriolar walls of the kidneys was more intense than that previously reported [14].…”

Prognostic Factors for Renal Amyloidosis:A Clinicopathological Study Using Cluster Analysis

“…Only a few studies have investigated the individual survival rate (4,38). Renal amyloidosis is associated with increased mortality in hemodialysis patients (36,39) and in patients with rheumatoid arthritis (40).…”

“…Several outcome studies have discussed the onset and progressive mechanisms of renal amyloidosis; however, detailed analyses of a large number of cases have not been undertaken (1)(2)(3)(4).…”