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Secondary Amyloidosis Presenting as Renal Failure

Mohamed Teleb, Jaime Gozalez, Jorge Bilbao, Miraie Wardi, Sarmad Said, Adeel Ahmad

(Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA)

Med Sci Case Rep 2015; 2:1-4

DOI: 10.12659/MSCR.893231


Background: Secondary amyloidosis is considered an uncommon cause of renal failure worldwide and is characterized by extracellular tissue deposition of fibrils composed mainly of amyloid A protein. Secondary amyloidosis is typically associated with chronic conditions such as ankylosing spondylitis, rheumatoid arthritis, inflammatory bowel disease, chronic infection, and neoplasms with idiopathic etiology described in only a small number of case reports. Biopsy diagnosis is made after a clinical presentation of renal failure. Treatment consists of targeting the underlying inflammatory condition and initiation of renal repalcement therapy (RRT) in the setting of deteriorating kidney function.
Case Report: We present the case of an 80-year-old male with no significant medical history who was transferred to our facility for arthoplasty of a right hip fracture and kidney injury. Common causes of possible acute kidney injury were ruled out. The patient eventually underwent kidney biopsy, which confirmed the diagnosis of secondary amyloidosis (AA). He agreed to have bone marrow biopsy but declined further work-up for primary (AL) or secondary (AA) amyloidosis. His kidney function continued to deteriorate and eventually required dialysis.
Conclusions: Secondary amyloidosis (AA) is a rare condition, usually affecting the kidneys. If suspected, diagnosis should be confirmed by tissue biopsy. Differentiating primary from secondary amyloidosis is necessary, as management is different. As in the case of our patient, renal replacement therapy is sometimes necessary in the setting of deteriorating kidney function.

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