Temporal artery involvement in AL amyloidosis: an important differential diagnosis for giant cell arteritis. A case report and literature review.

AL amyloidosis (AL) is a systemic disorder due to extracellular tissue deposition of amyloid fibrils, composed of immunoglobulin light chains. Since the description of AL involving temporal arteries in 1986, this disorder has been known as one of the differential diagnoses of giant cell arteritis (GCA). We encountered a case of an elderly female presenting with headache and tender and enlarged temporal arteries, that was pathologically diagnosed with temporal artery involvement of AL due to Bence-Jones-type MM. To our knowledge, this was the first case of AL with temporal artery involvement in Japan, that presented with GCA-like features. Literature review of AL cases with temporal artery involvement showed close similarity between these disorders, but suggested that vasculature involvement (extremity claudication, kidney or heart), macroglossia, carpal tunnel syndrome and normal or low (<0.5 mg/dL) CRP levels may predict AL rather than GCA. Physicians should keep in mind that AL involving temporal arteries can be a pitfall in the diagnosis of GCA, as seen in our and previous cases.

Icodextrin increases technique survival rate in peritoneal dialysis patients with diabetic nephropathy by improving body fluid management: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: There are still controversies whether peritoneal dialysis (PD) with icodextrin preserves residual renal and peritoneal membrane functions in patients with diabetes. However, there are no randomized controlled and long-term clinical trials in newly started PD patients with diabetic nephropathy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Forty-one patients with diabetic nephropathy with ESRD were enrolled and randomly assigned to the glucose group (GLU) treated with 8 L of 1.5% or 2.5% glucose or an icodextrin group (ICO) treated with 1.5 or 2.0 L of 7.5% icodextrin-containing solutions. Technique failure, body fluid management, glucose and lipid metabolism, and residual renal and peritoneal functions and were evaluated over 2 years. RESULTS: The technique survival rate was 71.4% in ICO and 45.0% in GLU, with most of the technique failure due to volume overload. ICO showed significantly better cumulative technique survival. Net ultrafiltration volume was significantly higher in ICO throughout the study period. There were no beneficial effects of icodextrin on hemoglobin A1c, glycoalbumin, and lipid profile at 24 months. Urine volume and residual renal function declined faster in ICO, but there were no significant differences between the two groups. For peritoneal function, no differences were observed in dialysis-to-plasma creatinine ratios during the observation. CONCLUSIONS: In PD therapy for diabetic nephropathy, the use of icodextrin-containing solutions has a beneficial effect on technique survival, but there are no apparent benefits or disadvantages in residual renal and peritoneal functions compared with conventional PD with glucose solution.

Clinical usefulness of a prognostic score in histological analysis of renal biopsy in patients with lupus nephritis.

OBJECTIVE: To evaluate active and chronic lesions in association with renal outcome according to the International Society of Nephrology/Renal Pathology Society classification in patients with lupus nephritis. METHODS: A retrospective analysis of 99 biopsy-proven subjects with lupus nephritis from 1990 to 2006 was performed in our center using the new classification. Each histological lesion was evaluated by multivariate survival analysis as predictive factor for renal insufficiency in patients with lupus nephritis, and independent predictors were graded to develop the prognostic score based on the regression coefficient. A receiver operating-characteristic curve based on the prognostic score was plotted to determine the most appropriate cutoff point. RESULTS: In class IV, the IV-G group tended to exhibit a worse renal outcome compared with the IV-S group, but the difference was not significant (log-rank test, p = 0.4330). Independent histological predictors of poor renal outcome were extracapillary proliferation, glomerular sclerosis, and fibrous crescents analyzed by Cox proportional hazards model, while predictors of favorable renal outcome were hyaline thrombi and fibrous adhesions. By the prognostic score, renal outcome was significantly worse in the group with the higher score (> or = 0.25) than in the group with the lower score (< 0.25) in class IV patients (log-rank test, p < 0.001). CONCLUSION: These results demonstrate the advantage of our prognostic score compared to subclasses in predicting the renal outcome of class IV patients [University Hospital Medical Information Network (UMIN) clinical trials registry, number UMIN 000001943].