tacrolimus and Amyloidosis

Topics: Adult; Amyloidosis; Basiliximab; Biopsy; Familial Mediterranean Fever; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Interleukin-1; Kidney Failure, Chronic; Kidney Transplantation; Male; Mycophenolic Acid; Prednisolone; Tacrolimus; Treatment Outcome; Young Adult

Topics: Amyloidosis; Azathioprine; Creatinine; Female; Fibrinogen; Gene Expression; Genes, Dominant; Graft vs Host Disease; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Function Tests; Liver Transplantation; Middle Aged; Mutation; Proteinuria; Tacrolimus; Treatment Outcome

To investigate the clinical characteristics and histopathological features of kidney disease in elderly patients.. We retrospectively analyzed the results of 4,185 consecutive renal biopsies, and 288 patients aged >60 years at the Second Hospital of Jilin University from January 1998 to December 2013 were finally included. All patients had been clinically and histologically diagnosed with kidney disease.. Nephrotic syndrome was the main clinical indication for biopsy. Twenty-four patients (8.33 %) experienced a minor complication related to their biopsy procedure. Among patients diagnosed as primary glomerulonephritis (GN), membranous nephropathy (MN) was the most frequent subclassification (24.7 %), followed by mesangioproliferative glomerulonephritis (MsPGN, 11.1 %) and IgA nephropathy (IgAN, 8.0 %). Amyloidosis (8.7 %) was the most common secondary GN, followed by antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune GN (5.2 %) and diabetic nephropathy (DN, 3.8 %). Based on renal biopsies results, 143/288 patients received immunosuppressive therapy and showed an overall remission rate (complete plus partial remissions) of 74.1 %. Among 71 MN patients, 29 patients received steroids plus cyclophosphamide and showed a remission rate of 79.3 %, while 42 patients received steroids and tacrolimus and showed a remission rate of 90.5 %. Among 25 patients with amyloidosis, 22 cases received melphalan plus dexamethasone and showed a remission rate of 40.9 %, while three patients received vincristine, adriamycin, and dexamethasone and showed a remission rate of 66.7 %.. Making an accurate pathologic diagnosis by renal biopsy is crucial for selecting the proper treatment for elderly patients with kidney disease.

Topics: Aged; Aged, 80 and over; Amyloidosis; Anti-Inflammatory Agents; Antibodies, Antineutrophil Cytoplasmic; Antineoplastic Agents, Alkylating; Autoimmune Diseases; Biopsy; Cyclophosphamide; Dexamethasone; Diabetic Nephropathies; Female; Glomerulonephritis, IGA; Glomerulonephritis, Membranoproliferative; Glomerulonephritis, Membranous; Humans; Immunosuppressive Agents; Kidney; Kidney Diseases; Male; Melphalan; Middle Aged; Nephrotic Syndrome; Retrospective Studies; Tacrolimus; Treatment Outcome

Proteinuria is an expected complication in transplant patients treated with mammalian target of rapamycin inhibitors (mTOR-i). However, clinical suspicion should always be supported by histological evidence in order to investigate potential alternate diagnoses such as acute or chronic rejection, interstitial fibrosis and tubular atrophy, or recurrent or de novo glomerulopathy. In this case we report the unexpected diagnosis of amyloidosis in a renal-transplant patient with pre-transplant monoclonal gammapathy of undetermined significance who developed proteinuria after conversion from tacrolimus to everolimus.

Topics: Allografts; Amyloidosis; Diagnosis, Differential; Everolimus; Female; Humans; Immunoglobulin G; Immunoglobulin lambda-Chains; Immunosuppressive Agents; Kidney Diseases; Kidney Transplantation; Middle Aged; Paraproteinemias; Polycystic Kidney, Autosomal Dominant; Postoperative Complications; Proteinuria; Tacrolimus; TOR Serine-Threonine Kinases

Primary localized cutaneous amyloidosis (PLCA) is caused by the extracellular deposition of amyloid material in the skin without other cutaneous or systemic organ involvement. PCLA is classified into lichen, macular,and nodular amyloidosis. Macular amyloidosis and lichen amyloidosis are named as biphasic amyloidosis when they are concurrently seen in a patient. The treatment of this disease is insufficient,even if there are several alternatives for treatment. Here we present a case of biphasic amyloidosis that responded well to topical tacrolimus ointment 0.1% plus narrow band ultraviolet B (NBUVB) treatment treatment to be able to generate a new treatment alternative model. With this case presentation, by reviewing of the treatment modalities of this rarely observed case, will contribute to the solution of the disease.

Topics: Adult; Amyloidosis; Female; Humans; Immunosuppressive Agents; Narrow Band Imaging; Ointments; Phototherapy; Tacrolimus; Ultraviolet Rays

To determine the possibility that T cells represent a potential target for therapy in AA amyloidosis.. AA amyloidosis was induced in C3H/HeN mice by concomitant administration of AgNO3 and amyloid-enhancing factor (AEF). Mice injected with AgNO3 and AEF received intraperitoneal injections of FK506 (2-200 microg/day). The degree of splenic amyloid deposition was determined by Congo red staining. Serum amyloid A (SAA), interleukin 1beta (IL-1beta), IL-6, and tumor necrosis factor-a concentrations were measured by ELISA. AA amyloidosis was also induced in ICR mice by injection of Freund's complete adjuvant (FCA) and Mycobacterium butyricum without AEF. ICR mice injected with FCA and M. butyricum also received intraperitoneal injections of FK506 (200 microg/day) to eliminate the possibility that FK506 action might depend upon AEF activity in the amyloid formation. Amyloid deposition was also induced with and without AEF in severe combined immunodeficient (SCID) mice and nude mice to clarify the role of T cells in the mechanism of amyloid formation in AA amyloidosis.. FK506 treatment significantly reduced the amount of amyloid deposition and incidence of amyloidosis without reducing serum SAA and proinflammatory cytokine levels in the murine AA amyloidosis models with and without AEF. SCID mice and nude mice showed resistance to development of AA amyloidosis.. Our findings may provide a new therapeutic strategy for amyloidosis. The results suggested that T cells may play an important role in the mechanism of amyloid formation in AA amyloidosis.

Topics: Amyloidosis; Animals; Immunosuppressive Agents; Liver; Male; Mice; Mice, Inbred C3H; Mice, SCID; Serum Amyloid A Protein; Spleen; T-Lymphocytes; Tacrolimus

Topics: Administration, Topical; Amyloidosis; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Lichen Planus; Middle Aged; Severity of Illness Index; Tacrolimus; Treatment Outcome