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- Title
IMPACT OF RECURRENT RESPIRATORY TRACT INFECTIONS ON THE DEVELOPMENT OF SECONDARY AA AMYLOIDOSIS.
- Authors
Mircea, Constantina-Maria; Mihai, Mihaela-Ionela; Măianu, Denisa; Moldovan, Raluca
- Abstract
Introduction: Renal amyloidosis is a condition caused by the deposition of abnormal, insoluble amyloid fibrils in the kidneys, associated with chronic inflammation due to recurrent infections or autoimmune.We present a case of renal amyloidosis secondary to a respiratory tract disease, highlighting relevant clinical aspects. Case Report: A 62-year-old man with a medical history that includes a cystic lung disease since childhood, probably genetic in nature, who has had recurrent episodes of infections over time, is brought to the nephrology ward with a diagnosis of sepsis, with pulmonary origin and severe anuric acute kidney injury.After admission, a nephrotic syndrome and a hepatitis B virus infection, probably chronic were identified. The patient was treated with supportive measures, antibiotics, renal replacement therapy, parenteral rehydration, electrolytes and acid-base rebalancing, which led to correction of respiratory symptoms, remission of the inflammatory syndrome and polyuria with improvement f renal function. Subsequently, the attention was focused on the diagnosis of nephrotic syndrome. Immunological tests, including antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, anti-PLA2R antibodies, anti-GBM antibodies and serum protein immunelectrophoresis, were negative. Ultrasonography revealed enlarged kidneys with thickened and hyperechogenic cortex, hepatomegaly. Renal biopsy was performed to identify the etiology of glomerular lesions, and histopathological examination led to the diagnosis of renal amyloidosis, acute tubular necrosis and chronic interstitial nephritis.Bone marrow aspiration was performed by the haematologist and did not show any abnormality. Thus, the diagnosis of renal AA amyloidosis was established. In order to determine the etiology and prognosis, several paraclinical investigations were performed. Discussions : The patient has not yet received a clear diagnosis for the childhood-onset lung disease. Clinical tests performed showed superinfected bronchiectasis and right basal pneumonia with suspected pulmonary cysts. Hepatitis B virus infection is being investigated to decide the need for antiviral treatment. After renal biopsy confirmation of the diagnosis of renal amyloidosis the patient returned to investigate the cause of the amyloidosis. The serum immunelectrophoresis, free light chains and the bone marrow aspiration were normal. A cardiac echo doppler was also performed, which did not show any changes suggestive of cardiac amyloidosis, which is important for the patient's prognosis. Conclusions: This case emphasizes the need for timely diagnosis, monitoring, and treatment of chronic respiratory infections to prevent secondary amyloidosis. Detection of amyloidosis in a patient with infection-related acute kidney injury underscores the disease's complexity, necessitating a multidisciplinary approach to management.
- Subjects
ROMANIA; RESPIRATORY infections; AMYLOIDOSIS; CONFERENCES &; conventions; DISEASE relapse
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p325
- ISSN
2668-7755
- Publication type
Article