Comparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome.
BACKGROUND
Amyloidosis leads to deposition of abnormal protein with beta-pleated sheet structure in specific compartments of the affected organs. The histological localization of these amyloid deposits determines the overall survival of the patient.


METHODS
In this study we have assessed the histological localization and severity of amyloid deposition in 35 patients with biopsy-proven renal amyloidosis and have compared those to clinical parameters, histo-pathological injury criteria and respective patient outcome. Comparisons were statistically analyzed using thus comparison between the different study groups, which was done using Student t-test and analysis of variance.


RESULTS
We find that the glomerulus is by far the most commonly and most severely affected renal compartment and patients with severe glomerular amyloidosis advance faster towards end stage renal disease (ESRD) and death, compared to those patients without glomerular amyloid deposits. Patients with severe glomerular amyloidosis showed higher serum creatinine and urine protein levels, while patients with severe vascular amyloidosis showed higher levels of interstitial inflammatory infiltrate.


CONCLUSIONS
In kidneys affected by amyloidosis, the amyloid proteins are predominantly deposited along vessels, especially the small vessels including glomerular capillary loops. The severity of glomerular amyloid deposition enhances the risk of developing ESRD and increases the risk for premature death.
Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. Ekaterina.castano@yale.edu.
Ekaterina
E
Castano
Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. matthew.palmer@uphs.upenn.edu.
Matthew B
MB
Palmer
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. cvign@ghneph.com.
Christine
C
Vigneault
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. randy.luciano@yale.edu.
Randy
R
Luciano
Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. serena.wong@yale.edu.
Serena
S
Wong
Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. gilbert.moeckel@yale.edu.
Gilbert
G
Moeckel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D007678:Kidney Glomerulus / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000682:Amyloid