Meneses Carlos F, Egües César A, Uriarte Miren, Belzunegui Joaquín, Rezola Marta
Department of Rheumatology, Universitario Donostia, San Sebastián, Spain.
Department of Pathology of Hospital, Universitario Donostia, San Sebastián, Spain.
Reumatol Clin. 2015 Jul-Aug;11(4):242-3. doi: 10.1016/j.reuma.2014.09.007. Epub 2014 Nov 14.
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.
我们报告一例45岁女性病例，有两年慢性肾功能不全和蛋白尿病史。肾活检显示存在AA型淀粉样变性（刚果红染色和免疫组化阳性）。其他器官无淀粉样沉积物证据，且无潜在疾病。AA型淀粉样变性通常继发于慢性炎症或感染性疾病。高水平的白细胞介素-1、白细胞介素-6和肿瘤坏死因子-α在淀粉样变性的发病机制中起作用，并诱导血清淀粉样蛋白A（SAA）的合成，SAA是组织淀粉样沉积物的前体。我们经验性地用低剂量秋水仙碱治疗该患者。患者反应良好。秋水仙碱已用于治疗家族性地中海热和相关自身炎症性疾病。为监测治疗反应，我们检测SAA发现其滴度较低。治疗开始后不久，就出现了蛋白尿改善和肾功能稳定的迹象。
