title: Control of AA amyloidosis complicating Crohn's disease: a clinico-pathological study.
abstract: BACKGROUND
  Immunosuppressive drugs may prevent or partially reverse progression of renal AA-amyloidosis, a rare complication of Crohn's disease, often fatal due to renal failure.
  
  
  METHODS
  The clinical, biological and pathological data of 16 patients treated since 1976 were reviewed. Serum amyloid A was determined in surviving patients.
  
  
  RESULTS
  The median age of the 16 patients (13 men) was 23·5 years (range 16-69). At Crohn's disease onset, Montreal phenotypes were similar to reported data. Out of 15 patients with renal insufficiency, 8 developed a nephrotic syndrome and 7 a low grade proteinuria. The single patient without renal insufficiency had nephrotic syndrome. A significant correlation (P < 0·05) between the extension of renal amyloid A and sclerosis was found in 12 patients. One patient had a 10 year remission of nephrotic syndrome with immunosuppressive drugs. In 6 patients treated with anti-TNF-α (Tumor-Necrosis-Factor-α) agents, anaphylactic reaction (1/6), death from septic shock (1/6), 5-year remission (1/6) or reduction of nephrotic syndrome (1/6) and stabilization of renal insufficiency (2/6) were observed. Surgery was performed in 10 patients. Kidney transplantation was performed in 5 of the 8 patients dialysed for end-stage renal failure. Among 6/16 patients (37%) still alive, 3 belong to the 5 transplanted patients (survival: 3-20 years) and 3 to the anti-TNF-α drugs treated patients; all but one exhibited a low serum amyloid A level.
  
  
  CONCLUSIONS
  Suppression of Crohn's disease inflammation potentially leads to the control of amyloid A production, assessed by a decrease of serum amyloid A. Kidney transplantation provides a long survival.
authors: Department of Gastroenterology, St. Luc University Hospital, Brussels, Belgium.
authors: Marie A
authors: MA
authors: Denis
authors: Jean-Pierre
authors: JP
authors: Cosyns
authors: Alexandre
authors: A
authors: Persu
authors: Olivier
authors: O
authors: Dewit
authors: Chantal
authors: C
authors: de Galocsy
authors: Pierre
authors: P
authors: Hoang
authors: Philippe
authors: P
authors: Maldague
authors: Pierre
authors: P
authors: Wallemacq
authors: Frank
authors: F
authors: Zerbib
authors: René
authors: R
authors: Fiasse
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D003424:Crohn Disease / Q000150:complications* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000096:biosynthesis*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000685:Serum Amyloid A Protein; D014409:Tumor Necrosis Factor-alpha