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Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis

  • Nephrology - Original Paper
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Abstract

Objective

The amount and distribution pattern of amyloid deposits may contribute to renal function and outcome, given the great diversity of renal involvement in amyloidosis. The aim of this study was to analyze the impact of histological characteristics of patients with biopsy-proven renal AA amyloidosis (AAA) on renal outcome.

Methods

Renal biopsies of 37 patients with AAA were re-evaluated. The distribution pattern of glomerular amyloid (GA) deposits was classified, the extent of amyloid deposits in glomeruli, vessel, and interstitium and other histopathologic lesions were scored, and renal amyloid prognostic score (RAPS) was determined by summing all scores. Their potential prognostic relevance on renal outcome was investigated.

Results

GA and vascular amyloid (VA) deposits were noted in all cases, interstitial amyloid (IA) was detected in 70.2%. GA deposits were predominantly seen in diffuse mesengiocapillary fashions (class IV) (51.4%). GA class, the extent of GA, VA, IA deposit, and RAPS, as well as interstitial fibrosis (IF) and interstitial inflammation were correlated to renal function at diagnosis. During the median follow-up of 52 months, 13 patients developed doubling of serum creatinine or end stage renal disease and they had a higher degree of GA and VA load (p = 0.03 and p = 0.042, respectively) as compared to the remaining patients. VA load, but not GA and RAPS grade, was associated with poor renal outcome (HR 3.016, 95% CI 1.45–6.25, p = 0.003).

Conclusions

Baseline renal function is closely linked to the extent of AA amyloid deposit in renal parenchyma but only VA load was a predictor of renal outcome in AAA patients.

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Acknowledgements

We would like to thank Emire Bor, EMPIAR Statistic, for performing the statistical analysis of the study.

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Authors and Affiliations

  1. Department of Nephrology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, 34147, Bakirkoy, Istanbul, Turkey

    Arzu Ozdemir, Mürvet Yılmaz & Sibel Yucel Kocak

  2. Department of Pathology, Sisli Hamdiye Etfal Education and Research Hospital, Halaskargazi Cd., 34371, Sisli, Istanbul, Turkey

    Ayse Aysim Ozagari

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  1. Arzu Ozdemir
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Correspondence to Arzu Ozdemir.

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This study was not supported by any third party and the work was received any financial support. Each author read the manuscript and agree with this submission. The authors declare that there is no conflict of interest with regard to the publication of this paper.

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Ozdemir, A., Yılmaz, M., Ozagari, A.A. et al. Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis. Int Urol Nephrol 54, 2591–2597 (2022). https://doi.org/10.1007/s11255-022-03163-y

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