[Response to anti-TNF-alpha treatment for secondary renal amyloidosis in a patient with ankylosing spondylitis].
Renal amyloidosis is a complication of ankylosing spondylitis. A possible pathogenetic role is due to TNF-alpha, with a direct action on glomerular receptors TNFR2 and renal injury, secondary to deposition of amyloid fibrils. The most frequent clinical manifestation is proteinuria or nephrotic syndrome. Etanercept, a soluble receptor of TNF-alpha, binds this circulant cytokine with a progressive improvement of renal function and reduction of deposits of amyloid. Transient leukopenia, observed during ankylosing spondylitis, should not be considered a controindication to the use of Etanercept, but it requires a constant monitoring. The benefit observed in our patient can represent an indication to the use of Etanercept for the management of amyloidosis.
Bellissimo
S
S
U.O.S.D. Reumatologia, Ospedale G. Rummo, Benevento, Italia. salvatorebellissimo@virgilio.it
Ferrucci
M G
MG
Gallo
A
A
Stisi
S
S
D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D000685:Serum Amyloid A Protein / Q000032:analysis; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000175:diagnosis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000685:Serum Amyloid A Protein; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept; D008775:Methylprednisolone; D007213:Indomethacin; D008727:Methotrexate