病态肥胖女性AA淀粉样变所致肾功能障碍。

Hassan Izzedine, Abhishek Nimkar, Joyita Bharati, Isabelle Brocheriou, Alexis Mathian, Frederic Charlotte, Kenar D Jhaveri, Sophie Georgin-Lavialle
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摘要

肾脏常累及全身性淀粉样变。系统性AA淀粉样变已知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。我们报告了一位48岁的病态肥胖女性,她表现为不明原因的持续性轻度肾功能障碍和低度蛋白尿。评估肾功能不全原因的尝试包括进行肾活检,尽管技术上存在挑战。肾活检显示AA淀粉样变伴主要血管沉积,说明肾范围蛋白尿的缺失。对系统性AA淀粉样变继发原因的评价为阴性。虽然我们的患者因病态肥胖而接受了袖式胃切除术,并有合理的反应,但从她的实验室标记物可以看出,持续的慢性炎症可能导致了AA淀粉样变。在接下来的6个月里,使用anakinra(一种白细胞介素-1拮抗剂)治疗后,实验室指标有所改善,她的肾功能保持稳定。本报告强调了病态肥胖中肾功能障碍的一个重要原因,AA淀粉样变的不典型表现,并强调了对这类患者进行肾脏活检的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Kidney dysfunction due to AA amyloidosis in a morbidly obese female.

Kidney dysfunction due to AA amyloidosis in a morbidly obese female.

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.

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