Introduction. Secondary renal amyloidosis due to tuberculosis is a debilitating disease with considerable mortality and morbidity due to renal failure and other manifestations of both amyloidosis and renal failure. Most patients with amyloidosis have been adequately treated with DOTS (Directly observed treatment, Short Course strategy). The aimof our study was to analyze the epidemiological and demographic profile of patients undergoing renal biopsy and found to have renal amyloidosis secondary to tuberculosis.
Methods. In this study, retrospective renal biopsy data was collected from 2009-2012 and patients with amyloidosis were identified and their clinical and biochemical parameters were analyzed.
Results. Incidence of amyloidosis was 4.66% (n=24/514) among total renal biopsies. Among this, secondary amyloidosis constituted 87.5% of total amyloidosis. The commonest etiology in these patients was pulmonary tuberculosis (73.5%). All patients with tuberculosis had previously received DOTS treatment. 47.5% of patients with amyloidosis had renal impairment and 10.5% developed end-stage renal disease over 12 months and were dialysis dependent.
Conclusions. Amyloidosis due to tuberculosis is a well-established, yet under-diagnosed complication of tuberculosis. The duration and treatment status of tuberculosis does not influence the occurrence of amyloidosis, as most of the patients were treated appropriately with DOTS. There are no predictive factors in patients who will develop secondary amyloidosis. At present there is no specific treatment apart from supportive therapy. The prognosis is poor, as most of these patients inexorably progress towards end-stage renal disease (ESRD) with significant mortality and morbidity. To conclude, at present we are only treating tuberculosis, we are yet to cure tuberculosis.
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1. Mohan A Sharma SK. History. In: Sharma SK Mohan A (editors). Tuberculosis. New Delhi Jaypee Brothers Medical Publishers 2nd edition 2009;5-13.
2. Jai Prakash Takhellambam Brojen Surendra Singh Rathore et al. The Changing Pattern of Renal Amyloidosis in Indian Subcontinent: Two Decades of Experience from a Single Center. Ren Fail 2012; Vol. 34 No.10: Pages 1212-1216.
3. SK Agarwal SC Dash. Spectrum of Renal Diseases in Indian Adults. J Assoc Physicians India 2000; 48(6): 594-600.
4. Chugh KS Datta BN Singhal PC et al. Pattern of renal amyloidosis in Indian patients. Post Graduate Medical Journal 1981; 57: 31-35.
5. Helen J Lachmann Hugh JB Goodman Janet A Gilbertson et al. Natural History and Outcome in Systemic AA Amyloidosis. N Engl J Med 2007; 356: 2361-2371.
6. Bouke PC Hazenberg. Amyloidosis. Rheumatic Disease Clinics of North America 2013; 39(2): 323-345.
7. Dember L. Amyloidosis associated Kidney Disease. J Am Soc Nephrol 2006; 17: 3458-3471.
8. Merlini G Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med 2003; 349: 583-596.
9. Giampaolo Merlini David C Seldin Morie A Gertz. Amyloidosis: Pathogenesis and New Therapeutic Options. J Clin Oncol 2011; 29(14): 1924-1933.
10. Gillmore JD Lovat LB Persey MR et al. Amyloid load and clinical outcome in AA amyloidosis in relation to circulating concentration of serum amyloid A protein. Lancet 2001; 358: 24-29.
11. Ramakant Dixit Rakesh Gupta Lokendra Dave et al. Clinical profile of patients having pulmonary tuberculosis and renal amyloidosis. Lung India 2009; Vol 26(2): 41-45.
12. Shah VB Phatak AM Shah BS et al. Renal amyloidosis-A clinicopathological study. Indian J Pathol Microbiol 1996; 39(3): 179-185.
13. Mehta HJ Talwalkar NC Merchant MR et al. Pattern of renal amyloidosis in western India-A study of 104 cases. J Assoc Physicians India 1990; 38(6): 407-410.
14. Tank SJ Chima RS Shah V et al. Renal amyloidosis following tuberculosis. Indian J Pediatr 2000; 67: 679-81.
15. Simons JP Al-Shawi R Ellmerich S et al. Pathogenetic mechanisms of amyloid A amyloidosis. Proceedings of the National Academy of Sciences 2013; 110(40): 16115-16120.
16. Le Roux DM Pillay K Nourse P et al. Systemic amyloidosis complicating multidrug-resistant tuberculosis in childhood. Pediatric Infectious Disease Journal 2012; 31(9): 994-997.
17. Dubrey SW Comenzo RL. Amyloid diseases of the heart: current and future therapies. QJM: An International Journal of Medicine 2012; Vol 105 Issue 7: 617-631.
18. Ambruzs JM Walker PD Larsen CP. The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. Clin J Am Soc Nephrol 2014; 9(2): 265-270.
19. Nelson Leung Samith H Nasr and Sanjeev Sethi. How I treat amyloidosis: the importance of accurate diagnosis and amyloid typing. Blood 2012; 120: 3206-3213.
20. Gottenberg JE Merle-Vincent F Bentaberry F et al. Anti–tumor necrosis factor α therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: A follow up report of tolerability and efficacy. Arthritis & Rheumatism 2003; 48: 2019-2024.
21. Elkayam O Hawkins PN Lachmann H et al. Rapid and complete resolution of proteinuria due to renal amyloidosis in a patient with rheumatoid arthritis treated with infliximab. Arthritis & Rheumatism 2002; 46: 2571-2573.
22. Ippei Miyagawa Shingo Nakayamada Kazuyoshi Saito et al. Study on the safety and efficacy of tocilizumab an anti-IL-6 receptor antibody in patients with rheumatoid arthritis complicated with AA amyloidosis. Modern Rheumatology 2013; 1-5.
23. Castellano I Gomez-Martino JR Hernandez MT et al. Remission of nephrotic syndrome caused by renal amyloidosis secondary to pulmonary tuberculosis after tuberculostatic treatment. Nefrologia 2001; 21: 88-91.
24. Guillaume Bollee Bruno Guery Dominique Joly et al. Presentation and Outcome of Patients with Systemic Amyloidosis Undergoing Dialysis. CJASN 2008; (2): 375-381.
25. Gertz MA Kyle RA O'Fallon WM. Dialysis support of patients with primary systemic amyloidosis: A study of 211 patients. Arch Intern Med 1992; 11: 2245-2250.
26. Martinez-Vea A Garcia C Carreras M et al. End-stage renal disease in systemic amyloidosis: Clinical course and outcome on dialysis. Am J Nephrol 1990; 4: 283-289.
27. Sanai T Nanishi F Nagata M et al. Role of amyloidosis in determining the prognosis of dialyzed patients with rheumatoid arthritis. Rheumatol Int 2007; 363-367.
28. Kuroda T Tanabe N Sato H et al. Outcome of patients with reactive amyloidosis associated with rheumatoid arthritis in dialysis treatment. Rheumatol Int 2006; 12: 1147-1153.
29. Claudio Ponticelli Gabriella Moroni and Richard J. Glassock. Recurrence of Secondary Glomerular Disease after Renal Transplantation. Clin J Am Soc Nephrol 2011; 6: 1214-1221.
30. Pinney JH Lachmann HJ Sattianayagam PT et al. Renal Transplantation in Systemic Amyloidosis-Importance of Amyloid Fibril Type and Precursor Protein Abundance. American Journal of Transplantation 2013; 13: 433-441.
31. Vivekanand Jha Vinay Sakhuja Kim Vaiphei et al. An Unusual Case of Recurrence of AA Amyloidosis in the Renal Allograft. Renal Failure 2004; 26(1): 89-92.
32. Dember LM Hawkins PN Hazenberg BP et al. Eprodisate for the Treatment of Renal Disease in AA amyloidosis Trial Group. N Engl J Med 2007; 356: 2349-2360.