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

Sasatomi, Yoshie; Sato, Hiroshi; Chiba, Yoshiro; Abe, Yasuhiro; Takeda, Seiji; Ogahara, Satoru; Murata, Toshiaki; Kaneoka, Hidetoshi; Takebayashi, Shigeo; Iwasaki, Hiroshi; Saito, Takao

doi:10.2169/internalmedicine.46.1690

Cited by 20 publications

(19 citation statements)

References 30 publications

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“…The damage in the tubular basement membrane and interstitium was evaluated using the point-counting method. 19 Under high magnification (400×) with an 81-point (100-square) eyepiece micrometer, we analyzed at least 10 consecutive and nonoverlapping cortical fields from each biopsy section. The points overlying damaged regions in the tubular basement membrane and interstitial space were counted and included in the area percent of damage [tubulointerstitial (TI) damage].…”

Section: Histopathology Of the Kidneymentioning

confidence: 99%

“…These patients were divided into four groups with regard to renal prognosis and survival. 19 For each group, the following parameters were reviewed at the time of the biopsy as possible candidates for factors that are related to the cluster group showing severe anemia: sex, body mass index [BMI; body weight/(body height) 2 (kg/m 2 )], age (years), systolic blood pressure (BP) (mmHg), diastolic BP (mmHg), duration after the diagnosis of DM (months), serum levels of albumin (mg/dL), blood urea nitrogen (BUN) concentrations (mg/dL), SCr concentrations (mg/dL), the estimated glomerular filtration rate [eGFR (mL/min/·1.73 m 2 )] that was validated in the Japanese population, 20 iron (Fe) levels (µg/dL), total cholesterol levels (mg/dL), triglyceride levels (mg/dL), fasting blood sugar levels (mg/dL), HbA1c (%) levels, urinary protein secretion (g/day), KW nodules, DGS index, and TI grade of damage (0 to +3).…”

Section: Histopathology Of the Kidneymentioning

confidence: 99%

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Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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Background: Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN. Methods: To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18-78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters. Results: The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel-Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis. Conclusion: Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.

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Section: Histopathology Of the Kidneymentioning

confidence: 99%

Section: Histopathology Of the Kidneymentioning

confidence: 99%

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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“…2,3 Renal involvement is very common in FMF-related SA, which is thus a prevalent cause of both microand macroproteinuria and chronic kidney disease (CKD) in this geographic region. [2][3][4] Regardless of primary cause, patients with CKD as a result of SA have an even poorer outcome than other CKD patients. [5][6][7] Although the exact causes for this is are not known, it has been suggested that SA itself is a cause of cardiovascular disease (CVD).…”

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confidence: 99%

ADMA Levels Correlate with Proteinuria, Secondary Amyloidosis, and Endothelial Dysfunction

Yılmaz¹,

Sönmez²,

Sağlam³

et al. 2008

Journal of the American Society of Nephrology

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Asymmetric dimethyl-arginine (ADMA), a residue of the proteolysis of arginine-methylated proteins, is a potent inhibitor of nitric oxide synthesis. The increased protein turnover that accompanies proteinuric secondary amyloidosis may increase circulating levels of ADMA, and this may contribute to endothelial dysfunction. We performed a cross-sectional study of 121 nondiabetic proteinuric patients with normal GFR (including 39 patients with nephrotic-range proteinuria and secondary amyloidosis) and 50 age-, sex-, and BMI-matched healthy controls. The proteinuric patients had higher levels of serum ADMA, symmetric dimethyl-arginine (SDMA), high-sensitivity C-reactive protein (hsCRP), and insulin resistance (homeostasis model assessment index) than controls. Compared with controls, brachial artery flow-mediated dilatation (FMD), serum L-Arginine, and the L-Arginine/ADMA ratio were significantly lower among proteinuric patients, suggesting greater endothelial dysfunction. When patients with secondary amyloidosis were compared with patients with glomerulonephritis who had similar levels of proteinuria, those with amyloidosis had higher ADMA and SDMA levels and lower L-Arginine/ADMA ratios and FMD measurements (P Ͻ 0.001 for all). Finally, even after adjusting for confounders, ADMA level correlated with both proteinuria and the presence of secondary amyloidosis, and was an independent predictor of FMD. We propose that ADMA synthesis may be increased in chronic kidney disease, especially in secondary amyloidosis, and this may explain part of the mechanism by which proteinuria increases cardiovascular morbidity and mortality.

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“…Bohle, et al reported that tubulointestinal damage in renal amyloidosis, and especially fibrosis, is an important determination of renal prognosis 8,9) . The rate of progression to renal failure is usually slow, but depends directly on the intensity of proteinuria and extension of amyloid deposits, especially in the vessels and tubules 10) .…”

Section: Discussionmentioning

confidence: 99%

A Long-Term Remission of Renal Amyloidosis With Nephrotic Syndrome After Autologous Peripheral Blood Stem-Cell Transplantation

Ogawa

Ikeda

Furukawa

et al. 2010

FJMS

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: Renal amyloidosis is typically characterized by nephrotic syndrome, often with massive proteinuria and refractory peripheral edema. We report the case of a patient with renal amyloidosis associated with nephrotic syndrome who maintained remission for 6 years after undergoing highdose chemotherapy followed by autologous peripheral blood stem -cell transplantation (auto -PBSCT). The patient was a man aged in his 50s who had developed nephrotic syndrome. Bone marrow aspiration and kidney biopsy determined that the cause of the nephrotic syndrome was renal amyloidosis due to multiple myeloma, and the patient was admitted to our department in July 2003. After one course of chemotherapy, auto -PBSCT was performed in March 2004. Following transplantation, serum M -protein was no longer detectable from March 2005, and the patient achieved complete hematological remission. Subsequently, proteinuria decreased, serum albumin levels normalized, and nephrotic syndrome improved. As of 6 years after transplantation, in March 2010, the patient remained in remission, meaning that auto -PBSCT proved extremely effective as a treatment for renal amyloidosis in this case.

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

Abstract: Objective There is no standardized therapy for renal amyloidosis, which shows rapid progression and poor prognosis. Here, we used

Cited by 20 publications

References 30 publications

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

ADMA Levels Correlate with Proteinuria, Secondary Amyloidosis, and Endothelial Dysfunction

A Long-Term Remission of Renal Amyloidosis With Nephrotic Syndrome After Autologous Peripheral Blood Stem-Cell Transplantation

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