Evaluation of CD68 + macrophages in relation to kidney outcomes in immunoglobulin light-chain amyloidosis.
Amyloid accumulation is associated with a nine-fold higher risk of renal replacement therapy.
Evaluation of CD68 + macrophages in relation to kidney outcomes in immunoglobulin light-chain amyloidosis.
The clinical course of systemic amyloidosis reflects the equilibrium between amyloid deposition and clearance, which varies across disease contexts.
Among 396 patients in the cohort who had serial serum amyloid P component (SAP) scans at diagnosis and at two-years of follow-up, the relationship between change in amyloid burden and long-term kidney outcomes was characterized.
amyloid buildup increased the risk of needing kidney dialysis nine times
At five years, cumulative incidence of renal replacement therapy (renal replacement therapy) was 14%, 22%, 40%, and 52% across macrophage scores 0-3 respectively.
On multivariable Cox regression analysis, each one-point macrophage score increase independently and significantly predicted higher risk of renal replacement therapy (hazard ratio 1.31, 95% confidence interval 1.09-1.56) alongside baseline estimated glomerular filtration rate, proteinuria, and interstitial fibrosis and tubular atrophy.
In amyloidosis amyloidosis, kidney CD68 + macrophage infiltration at diagnosis is independently associated with risk of progression to renal replacement therapy even among patients with deep hematologic response.
Regression of amyloid is associated with prolonged kidney survival.
These findings highlight kidney CD68 + macrophage infiltration and subsequent SAP-defined amyloid regression as complementary predictors of kidney outcome in amyloidosis amyloidosis.