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Vol. 11. Issue 4.
Pages 242-243 (July - August 2015)
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Vol. 11. Issue 4.
Pages 242-243 (July - August 2015)
Case report
DOI: 10.1016/j.reumae.2014.09.005
Colchicine use in isolated renal AA amyloidosis
Uso de colchicina en amiloidosis AA renal aislada
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Carlos F. Menesesa,
Corresponding author
, César A. Egüesa, Miren Uriartea, Joaquín Belzuneguia, Marta Rezolab
a Department of Rheumatology, Universitario Donostia, San Sebastián, Spain
b Department of Pathology of Hospital, Universitario Donostia, San Sebastián, Spain
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Abstract

We present the case of a 45-year-old woman, with two-year history of chronic renal insufficiency and proteinuria. A kidney biopsy showed the presence of AA amyloidosis (positive Congo red staining and immunohistochemistry). There was no evidence of amyloid deposits in other organs and there was no underlying disease. AA amyloidosis normally is secondary to chronic inflammatory or infectious diseases. High levels of IL-1, IL-6 and TNF-α play a role in the pathogenesis of amyloidosis and induce the synthesis of serum amyloid A protein (SAA), a precursor of tissue amyloid deposits. We empirically treated the patient with a low dose colchicine. The patient responded well. Colchicine has been used for the treatment of Familiar Mediterranean Fever and related auto-inflammatory diseases. To monitor treatment responses, we measured SAA finding low titers. Soon after treatment onset there were signs of improvement pertaining to proteinuria and stabilization of renal function.

Keywords:
Colchicine
Serum A amyloid protein
SAA
Amyloidosis
Renal AA amyloidosis
Congo red
Resumen

Se presenta el caso de una paciente de 45 años de edad con insuficiencia renal crónica y proteinuria. La biopsia renal demostró una amiloidosis tipo AA con un estudio de extensión negativo para depósitos en otros órganos. No se detectó enfermedad asociada. La amiloidosis tipo AA se asocia habitualmente a una enfermedad crónica inflamatoria o infecciosa. Las interleucinas IL1, IL-6 y TNF son responsables de la síntesis hepática de la proteína sérica amiloide A (SAA), precursor del amiloide que se deposita en los tejidos. Ante la imposibilidad de tratar una amiloidosis sin evidencia de enfermedad subyacente, instauramos empíricamente tratamiento con colchicina con buenos resultados. La colchicina es eficaz para el tratamiento de la fiebre mediterránea familiar y otros procesos inflamatorios. Se midieron niveles de la SAA en sangre que inicialmente fueron muy elevados alcanzándose niveles normales al poco tiempo de tratamiento con mejoría de la proteinuria, manteniéndose estable la función renal.

Palabras clave:
Colchicina
Proteína sérica amiloide A
SAA
Amiloidosis
Renal AA amiloidosis
Rojo congo

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