Sekonder Amiloidozu ve Böbrek Tutulumu Olan Hastalarda Prognozu Etkileyen Faktörler

Abstract

Prognostic markers in AA amyloidosis patients with kidney involvement. Kidney disease is the most important cause of morbidity and mortality in patients with AA amyloidosis. Data is scarce regarding outcome in AA amyloidosis with kidney involvement and response to therapy in a population which familial Mediterranean fever (FMF) is the primary cause of AA amyloidosis. One hundred and eleven patients were diagnosed with AA amyloidosis and kidney involvement in our unit between January 2000 and June 2012. Eighty of them with estimated glomerular filtration rate over 20 ml/min/1.73m² were followed for a median of 39 months. We evaluated clinical and laboratory data at the diagnosis and at the end of follow up to investigate factors affecting kidney survival and mortality. Primary disease underlying AA amyloidosis were FMF in 55 (68.8%) patients. Median kidney survival was 86 months. Baseline serum creatinine (HR=3.81 [95% CI: 2.28?6.37]; p<0.001) and serum albumin levels (HR=0.45 [95% CI: 0.28?0.74]; p=0.001) were independent prognostic factors for kidney survival. Renin-angiotensin-aldosterone system (RAAS) blockers did not significantly change the kidney outcome (HR= 0.54 [% 95 CI: 0.25?1.14]; p=0.107]. Serum creatinine (HR=4.38 [95% CI: 2.01?9.51]; p<0.001) and serum albumin levels (HR=0.72 [95% CI: 0.57-0.90)]; p=0.018) were also independent predictors of survival with hemoglobin (HR=0.39 [95% CI: 0.18?0.85]; p=0.005). Our results showed that in AA amyloidosis patients with kidney involvement, baseline serum creatinine and albumin at the diagnosis were the most important predictors of both renal survival and mortality.