Izzedine Hassan, Nimkar Abhishek, Bharati Joyita, Brocheriou Isabelle, Mathian Alexis, Charlotte Frederic, Jhaveri Kenar D, Georgin-Lavialle Sophie
Department of Nephrology, Peupliers Private Hospital, Paris, France.
Division of Kidney Diseases and Hypertension at Northwell Health, Donald and Barbara Zucker School of Medicine, Northwell Health, NY, USA.
Clin Nephrol Case Stud. 2023 Jul 28;11:121-125. doi: 10.5414/CNCS111133. eCollection 2023.
Kidneys are commonly involved in systemic amyloidosis. Systemic AA amyloidosis is known to be associated with states of chronic inflammation such as autoimmune conditions, chronic infections, and malignancies. Obesity is increasingly recognized to be a risk factor for low-grade, chronic inflammation. We report a 48-year-old female with morbid obesity who presented with unexplained persistent mild kidney dysfunction and low-grade proteinuria. Attempt at evaluating the cause of kidney dysfunction included performing kidney biopsy despite technical challenges. Kidney biopsy showed AA amyloidosis with predominant vascular deposition, explaining the absence of nephrotic-range proteinuria. Evaluation for secondary causes of systemic AA amyloidosis was negative. While our patient was treated with sleeve gastrectomy for morbid obesity with reasonable response, it is likely that ongoing chronic inflammation, reflected by her laboratory markers, resulted in AA amyloidosis. Treatment with anakinra, an interleukin-1 antagonist, led to improvement in the laboratory markers in the next 6 months, and her kidney function remained stable. This report highlights an important cause of kidney dysfunction in morbid obesity, an atypical presentation of AA amyloidosis, and emphasizes the value of kidney biopsy in such patients.
肾脏常累及系统性淀粉样变。已知系统性AA淀粉样变与慢性炎症状态相关，如自身免疫性疾病、慢性感染和恶性肿瘤。肥胖越来越被认为是低度慢性炎症的一个危险因素。我们报告一名48岁的病态肥胖女性，她出现了不明原因的持续性轻度肾功能不全和低度蛋白尿。尽管存在技术挑战，但仍尝试通过肾活检来评估肾功能不全的原因。肾活检显示为以血管沉积为主的AA淀粉样变，这解释了为何没有肾病范围的蛋白尿。对系统性AA淀粉样变的继发原因评估为阴性。虽然我们的患者接受了袖状胃切除术治疗病态肥胖，且反应良好，但很可能是她实验室指标所反映的持续慢性炎症导致了AA淀粉样变。使用白细胞介素-1拮抗剂阿那白滞素治疗在接下来的6个月里使实验室指标得到改善，且她的肾功能保持稳定。本报告强调了病态肥胖中肾功能不全的一个重要原因，即AA淀粉样变的非典型表现，并强调了肾活检在此类患者中的价值。
