Renal Infarction and Its Consequences for Renal Function in Patients With Cardiac Amyloidosis.

Abstract

OBJECTIVE:

To describe the prevalence of and risk factors for renal infarction (RI) in patients with cardiac amyloidosis.

PATIENTS AND METHODS:

We evaluated 87 patients with cardiac amyloidosis who underwent renal technetium-99m-labeled dimercaptosuccinic acid scintigraphy in the Amyloidosis Referral Center of Henri-Mondor Hospital from October 1, 2015, through February 28, 2018.

RESULTS:

Three groups of patients were identified according to the underlying amyloidosis disorder: AL amyloidosis in 24 patients, mutated-transthyretin amyloidosis in 24 patients, and wild-type transthyretin amyloidosis in 39 patients. Patients with wild-type transthyretin amyloidosis were older (P<.001), more likely to be men (P=.02), to have arrhythmic heart diseases (P<.001), and to be receiving anticoagulation treatment (P<.001). Patients with AL amyloidosis had significantly higher N-terminal pro-B-type natriuretic peptide levels (P=.02) and were more likely to have nephrotic syndrome (P<.001). Renal infarction was detected in 18 patients (20.7%), at similar frequencies in the various groups. Baseline urinary protein to creatinine ratio was the only parameter for which a significant difference (P=.03) was found between patients with and without RI diagnoses. The likelihood of RI diagnosis was 47.1% (8 of 17) in the presence of AKI and 14.5% (10 of 69) in its absence (P=.003). Overall, heart transplant-censored patient survival did not differ significantly between patients with and without RI (P=.64), but death- and heart transplant-censored renal survival was significantly lower in patients with RI (P<.001).

CONCLUSION:

Our study suggests that prevalence of RI in patients with cardiac amyloidosis is higher than previously thought, regardless of the underlying amyloidosis disorder. Acute kidney injury in a patient with cardiac amyloidosis should alert clinicians to the possibility of RI.

• Authors: Julien Dang, Mukedaisi Abulizi, Anissa Moktefi, Khalil El Karoui, Jean-François Deux, Diane Bodez, Fabien Le Bras, Karim Belhadj, Philippe Remy, Pauline Issaurat, Violaine Plante-Bordeneuve, Valérie Molinier-Frenkel, Pascale Fanen, Soulef Guendouz, Mounira Kharoubi, Emmanuel Itti, Thibaud Damy, Vincent Audard
• Journal: Mayo Clinic proceedings (Mayo Clin Proc) Vol. 94 Issue 6 Pg. 961-975 (06 2019) ISSN: 1942-5546 [Electronic] England
• PMID: 31103217 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Chemical References

• Radiopharmaceuticals
• technetium Tc 99m hydroxymethylene diphosphonate
• Technetium Tc 99m Medronate

Topics

• Acute Kidney Injury (diagnostic imaging, pathology)
• Aged
• Aged, 80 and over
• Amyloid Neuropathies, Familial (complications)
• Female
• Heart Diseases (diagnosis, pathology)
• Humans
• Male
• Radionuclide Imaging
• Radiopharmaceuticals (administration & dosage)
• Technetium Tc 99m Medronate (analogs & derivatives)