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Persistence of β2-Microglobulin Amyloidosis 20 Years After Successful Kidney Transplantation

2007; Elsevier BV; Volume: 50; Issue: 1 Linguagem: Inglês

10.1053/j.ajkd.2007.04.023

1523-6838

Laura Labriola, Christian Garbar, Michel Jadoul,

Bipolar Disorder and Treatment

The fate of β2-microglobulin (β2MG) amyloid deposits after kidney transplantation remains uncertain. The rapid clinical improvement, possibly related to steroids, contrasts with the radiologic stability of amyloid bone cysts.1Bardin T. Lebail-Darné J.L. Zingraff J. et al.Dialysis arthropathy: outcome after renal transplantation.Am J Med. 1995; 99: 243-248Abstract Full Text PDF PubMed Scopus (56) Google Scholar Early recurrence of severe symptoms after graft failure and resumption of hemodialysis suggests that β2MG-amyloid deposits do not regress after a successful kidney transplantation2Mourad G. Argilés A. Renal transplantation relieves the symptoms but does not reverse β2 microglobulin amyloidosis.J Am Soc Nephrol. 1996; 7: 798-804PubMed Google Scholar whereas the significance of reduced uptake of 123I-serum amyloid P-component after transplantation3Tan S.Y. Irish A. Winearls C.G. et al.Long term effect of renal transplantation on dialysis-related amyloid deposits and symptomatology.Kidney Int. 1996; 50: 282-289Crossref PubMed Scopus (68) Google Scholar has been debated.4Jadoul M. Drüeke T. Zingraff J. et al.Does dialysis-related amyloidosis regress after transplantation?.Nephrol Dial Transplant. 1997; 12: 839-841Crossref PubMed Scopus (19) Google Scholar We reported earlier in this Journal the persistence of histological β2MG-amyloidosis 10 years after a successful kidney transplantation. Our patient was transplanted in 1982 after 7 years of cuprophane hemodialysis complicated by bilateral carpal tunnel syndrome and typical amyloid bone cysts.5Jadoul M. Noel H. Malghem J. et al.Histological β2 microglobulin amyloidosis 10 years after a successful renal transplantation.Am J Kidney Dis. 1996; 27: 888-890Abstract Full Text PDF PubMed Scopus (16) Google Scholar We now report on the autopsy performed on the same patient over 9 years later. Throughout follow-up, the serum creatinine remained nearly constant at 1.5 mg/dL (133 μmol/L) or less, and estimated glomerular filtration rate was around 50 mL/min/1.73 m2 (0.83 mL/s/1.73 m2).Sections from the sternoclavicular joint obtained at autopsy showed amyloid deposits staining with Congo red and presenting the typical green birefringence under polarized light (Fig 1A). The amyloid deposits were strongly stained with a peroxidase-coupled antibody (Fig 1B). In summary, this extends the longest follow-up with persistent β2MG-amyloid from 10 years1Bardin T. Lebail-Darné J.L. Zingraff J. et al.Dialysis arthropathy: outcome after renal transplantation.Am J Med. 1995; 99: 243-248Abstract Full Text PDF PubMed Scopus (56) Google Scholar, 5Jadoul M. Noel H. Malghem J. et al.Histological β2 microglobulin amyloidosis 10 years after a successful renal transplantation.Am J Kidney Dis. 1996; 27: 888-890Abstract Full Text PDF PubMed Scopus (16) Google Scholar, 6Kessler M. Aymard B. Pourel J. Persistance of β2 microglobulin amyloid 10 years after renal transplantation.Nephrol Dial Transplant. 1994; 9: 333-334PubMed Google Scholar to nearly 20 years after a successful kidney transplantation, thus supporting the hypothesis that the regression of β2MG-amyloid deposits is at best very slow.Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors. The fate of β2-microglobulin (β2MG) amyloid deposits after kidney transplantation remains uncertain. The rapid clinical improvement, possibly related to steroids, contrasts with the radiologic stability of amyloid bone cysts.1Bardin T. Lebail-Darné J.L. Zingraff J. et al.Dialysis arthropathy: outcome after renal transplantation.Am J Med. 1995; 99: 243-248Abstract Full Text PDF PubMed Scopus (56) Google Scholar Early recurrence of severe symptoms after graft failure and resumption of hemodialysis suggests that β2MG-amyloid deposits do not regress after a successful kidney transplantation2Mourad G. Argilés A. Renal transplantation relieves the symptoms but does not reverse β2 microglobulin amyloidosis.J Am Soc Nephrol. 1996; 7: 798-804PubMed Google Scholar whereas the significance of reduced uptake of 123I-serum amyloid P-component after transplantation3Tan S.Y. Irish A. Winearls C.G. et al.Long term effect of renal transplantation on dialysis-related amyloid deposits and symptomatology.Kidney Int. 1996; 50: 282-289Crossref PubMed Scopus (68) Google Scholar has been debated.4Jadoul M. Drüeke T. Zingraff J. et al.Does dialysis-related amyloidosis regress after transplantation?.Nephrol Dial Transplant. 1997; 12: 839-841Crossref PubMed Scopus (19) Google Scholar We reported earlier in this Journal the persistence of histological β2MG-amyloidosis 10 years after a successful kidney transplantation. Our patient was transplanted in 1982 after 7 years of cuprophane hemodialysis complicated by bilateral carpal tunnel syndrome and typical amyloid bone cysts.5Jadoul M. Noel H. Malghem J. et al.Histological β2 microglobulin amyloidosis 10 years after a successful renal transplantation.Am J Kidney Dis. 1996; 27: 888-890Abstract Full Text PDF PubMed Scopus (16) Google Scholar We now report on the autopsy performed on the same patient over 9 years later. Throughout follow-up, the serum creatinine remained nearly constant at 1.5 mg/dL (133 μmol/L) or less, and estimated glomerular filtration rate was around 50 mL/min/1.73 m2 (0.83 mL/s/1.73 m2). Sections from the sternoclavicular joint obtained at autopsy showed amyloid deposits staining with Congo red and presenting the typical green birefringence under polarized light (Fig 1A). The amyloid deposits were strongly stained with a peroxidase-coupled antibody (Fig 1B). In summary, this extends the longest follow-up with persistent β2MG-amyloid from 10 years1Bardin T. Lebail-Darné J.L. Zingraff J. et al.Dialysis arthropathy: outcome after renal transplantation.Am J Med. 1995; 99: 243-248Abstract Full Text PDF PubMed Scopus (56) Google Scholar, 5Jadoul M. Noel H. Malghem J. et al.Histological β2 microglobulin amyloidosis 10 years after a successful renal transplantation.Am J Kidney Dis. 1996; 27: 888-890Abstract Full Text PDF PubMed Scopus (16) Google Scholar, 6Kessler M. Aymard B. Pourel J. Persistance of β2 microglobulin amyloid 10 years after renal transplantation.Nephrol Dial Transplant. 1994; 9: 333-334PubMed Google Scholar to nearly 20 years after a successful kidney transplantation, thus supporting the hypothesis that the regression of β2MG-amyloid deposits is at best very slow. Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors. Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors. Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice. Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors.