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Diagnosis: AA amyloidosis
AA-amyloidosis is a systemic disease whose clinical course is characteristically dominated by the renal dysfunction. Patients typically present with nephrotic range proteinuria, nephrotic syndrome and slowly progressive chronic kidney disease, frequently leading to end-stage kidney disease. AA-amyloidosis results from the deposition of insoluble amyloid fibrils derived from circulating serum amyloid-A (SAA) protein, an acute phase reactant associated with many chronic inflammatory conditions. The majority of cases have been attributed to rheumatic conditions, followed by chronic infections, malignancy, and other inflammatory conditions. However, the direct association between HIV infection and AA-amyloidosis has been sporadically documented. Because of the frequency related to other inflammatory conditions in this population, HIV is probably not an independent risk factor for AA amyloidosis. Treatment strategies mainly revolve around targeting the underlying inflammatory condition. Previous works suggest that HAART can be employed to reverse HIV related renal AA-amyloidosis. (Borg J, et al. Treatment of renal AA-Amyloidosis associated with human immunodeficiency virus infection: a case report. CEN Case Rep. 2021;10:88-93. [PubMed link]).
See the chapter: Amyloidosis and Other... of our Tutorial.
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References
- Breillat P, Pourcher V, Deshayes S, Buob D, Cez A, Michel PA, Boffa JJ, Langlois V, Grateau G, Georgin-Lavialle S. AA Amyloidosis in the Course of HIV Infection: A Report of 19 Cases Including 4 New French Cases and a Comprehensive Review of Literature. Nephron. 2021;145(6):675-683. [PubMed link]
- Borg J, Buttigieg J, Holwill S, Azzopardi CM. Treatment of renal AA-Amyloidosis associated with human immunodeficiency virus infection: a case report. CEN Case Rep. 2021;10(1):88-93. [PubMed link]
- Amarawardena WK, Wijesundere A, Manohari HA. Amyloidosis associated with HIV infection. Ceylon Med J. 2013;58(3):128-9. [PubMed link]
- Jung O, Haack HS, Buettner M, Betz C, Stephan C, Gruetzmacher P, Amann K, Bickel M. Renal AA-amyloidosis in intravenous drug users--a role for HIV-infection? BMC Nephrol. 2012;13:151. [PubMed link]
- Vali PS, Ismal K, Gowrishankar S, Sahay M. Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy. Indian J Nephrol. 2012;22(2):98-102. [PubMed link]