Clinical And Pathological Analysis Of Renal Amyloidosis

Objective:To analyze the clinical manifestations and pathological features of renal amyloidosis in order to improve the understanding of the disease and provide help for clinical diagnosis and treatment.Methods:Retrospective analysis of 15 cases of patients amyloidosis with diagnosed by biopsy form the May 2007 to December 2016 in the first hospital of Yunnan province,examination main clinical features,laboratory and imaging analysis,including hospitalization for urine,24 hours urine protein,blood routine,blood biochemistry,blood sedimentation,estimated glomerular filtration rate(eGFR),abdominal ultrasound,electrocardiogram,cardiac ultrasound examination,etc.and renal tissue pathology.Results:In 15 patients,male 8 cases,female 7 cases,male to female ratio was 1.14:1,the average age was(59.3 + 7.4)years old,male an average age was 60.3,women an average age was 58.1,among cases,over 60 years of age accounted for 60%;in the course of varying lengths,median duration of the disease is 10 months,2 patients with hypertension,2 cases patients with elevated blood pressure after the onset,1 patients with a history of diabetes based,1 cases of patients with HIV infection;Accompanied by nephrotic syndrome which the main clinical manifestations are nausea,vomiting and abdominal distension of the gastrointestinal symptoms;Blood pressure level in most patients is not high.The average blood pressure is(111.33 + 17.78)/(72.67 +10.33)mmHg;The patients eGFR was(90.95 + 32.01)(ml/min/1.73 m),more than half of patients eGFR<90ml/min/1.73 square meters when they are treated,including women EGFR average was 85.6ml/min/1.73 square meters,was significantly lower than that the average value of 95.6ml/min/1.73 square meters in male patients;all the patients had no microscopic or gross hematuria,had proteinuria,24 hour urinary protein quantitative average was(5976.34 + 1263.55)mg;echocardiography were abnormal,many patients had clinical features of abnormal electrocardiogram,high ESR,hyperlipidemia;15 cases of patients with renal biopsy in Congo red staining were positive,patients with immune pathological staining were 2 cases,including 1 cases of kappa light chain type,the other 1 cases without positive expression of renal tissue pathology;the most common manifestation under light microscope in mesangial widened,interstitial fibrosis and vacuolar degeneration in renal tubular epithelial cells,glomerular basement membrane thickening,interstitial inflammatory cell infiltration,tube type;the most common site of amyloid deposition in glomerular mesangial deposition,were small arterial wall,renal interstitium,glomerular basement membrane deposition.Two of 15 cases of renal tissue in patients with direct immunofluorescence staining were negative,the rest of the patients had IgG,IgA,IgM,complement C3,Clq negative or positive deposition.Conclusion:Renal amyloidosis is relatively rare in clinical practice.It is difficult to diagnose in early stage,and most patients often have different degrees of organ dysfunction.For the manifested as nephrotic syndrome in elderly patients,hematuria is rare,renal injury occurred early,cardiac ultrasound was abnormalities,anemia performance occurred.Thus,this disease should be alerted,in the absence of contraindications renal biopsy diagnosis should be performed as early as possible.