Evaluation of renal and patient prognosis in patients diagnosed with amyloidosis by renal biopsy

Aim: The kidney is the most frequently affected organ by amyloidosis and has great importance for patient survival in amyloidosis. We aimed to examine the factors that may affect the renal and patient survival in patients diagnosed with renal amyloidosis by biopsy. Method: Clinical and laboratory findings of patients diagnosed with amyloidosis in kidney biopsies performed at Necmettin Erbakan University Faculty of Medicine Hospital between 2012 and 2021 were retrospectively analyzed. Primary or secondary causes were revealed by examining the etiologies of amyloidosis. Age, gender, biopsy date, comorbidities, colchicine use, hemodialysis treatment status, time from biopsy to hemodialysis treatment (if receiving hemodialysis treatment), right/exitus status during follow-up, creatinine, uric acid, serum total protein, serum albumin, C-reactive protein, 24- hour urine protein values were recorded and statistically evaluated. The data were recorded and statistically evaluated using R 4.2.2 and SPSS 26.0 (Statistical Package for Social Sciences) package programs. Chi-square, independent sample T, Mann Whitney U tests, Pearson correlations and mixed effect models were used. Cox regression analysis was used for survival analysis and determination of prognostic factors. Results: The mean follow-up period of the patients was determined as 44,90 ±32,24 months. It was found that the renal (p=0.004) and overall survival (p=0.052) of patients with primary amyloidosis were worse. The average starting time to hemodialysis in patients with primary amyloidosis was significantly lower than secondary patients (p=0.009). High age of the patients at diagnosis (p=0.017), high seum creatinine value (p=0.002) and low albumin value (p=0.01) were found to be negative prognostic factors in terms of renal survival. Overall survival was found to be worse in the group with older age at diagnosis (p=0.005). Colchicine use did not significantly affect renal survival (p=0.96) and mortality (p=0.13) in patients with secondary amyloidosis. The overall survival of patients who received hemodialysis during follow-up was found to be significantly lower (p=0.01). Conclusion: At the end of the study, we found that primary amyloidosis was worse in terms of renal survival and mortality, lower age at the time of diagnosis was a positive prognostic factor for renal and patient survival. We found that high serum albumin at the time of diagnosis was a positive prognostic factor for renal survival. We found that colchicine use did not significantly affect renal survival and mortality in patients with secondary amyloidosis. We also concluded that renal survival affects mortality in amyloidosis. Keywords: Amyloidosis, Renal survival, Prognosis of renal amyloidosis