Clinical outcome of immunoglobulin light chain amyloidosis affecting the kidney
Gertz MA et al. - Data suggest that presenting 24-h urine protein loss and creatinine values may predict which patients presented with immunoglobulin light chain amyloidosis (AL) will require dialysis. Median survival for pts starting dialysis is <1 year; presence of λ light chain amyloid predicts the increased likelihood of renal involvement. Methods- Study to investigate the long-term predictors for and outcomes after renal replacement therapy in pts with AL
- Kaplan–Meier and multivariate analyses performed in a uniformly treated cohort of 145 pts monitored for 11 yrs
- Outcome measurements were needed for renal replacement therapy and survival
Results- Among pts presenting with renal AL, 42% received renal replacement therapy vs 5% pts w/o
- Pts with renal amyloid who received dialysis support had higher serum creatinine and 24-h urine protein levels
- Pts with λ light chain amyloid had more renal involvement and had greater urinary protein loss vs pts with κ light chain amyloid
- Serum creatinine level was an independent predictor of overall survival when corrected for cardiac involvement
- For 38 pts who received dialysis, median survival from day 1 of dialysis was 10.4 mo
- 26% of patients with AL ultimately received renal replacement therapy vs 42% of patients who presented with renal AL specifically
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