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Amyloidosis and kidney damage - Prognosis
Last reviewed: 06.07.2025
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Amyloidosis is characterized by a steadily progressive course. The prognosis of amyloidosis depends on the type of amyloid, the degree of involvement of various organs, mainly the heart and kidneys, the presence and nature of the predisposing disease.
With AL-type amyloidosis, the prognosis is the most serious. According to the Mayo Clinic, the average life expectancy of patients with this type of amyloidosis is only 13.2 months, 5-year survival is 7%, 10-year survival is only 1%. At the same time, the lowest life expectancy is noted in patients with congestive circulatory failure (6 months) and orthostatic arterial hypotension (8 months). The life expectancy of patients with nephrotic syndrome is on average 16 months. In the presence of myeloma disease, the prognosis of AL-type amyloidosis worsens, the life expectancy of patients is shortened (5 months). The most common causes of death in patients with AL-type amyloidosis are heart failure and heart rhythm disturbances (48%), uremia (15%), sepsis and infections (8%). Despite the fact that death from uremia is observed much less frequently than from cardiac causes, chronic renal failure of varying degrees of severity is recorded in more than 60% of those who die.
With AA-type amyloidosis, the prognosis is more favorable, depending mainly on the nature of the predisposing disease and the possibility of its control. The average life expectancy of patients with this type of amyloidosis from the moment of diagnosis verification is 30-60 months (longer with secondary amyloidosis, shorter with amyloidosis in the context of periodic disease). Effective treatment of predisposing diseases, including complete cure of tuberculosis or chronic suppuration, in many patients leads to the disappearance or reduction of clinical manifestations of amyloidosis, improving the prognosis; less often, amyloidosis continues to progress, but at a slower rate. Effective therapy of rheumatoid arthritis allows to prolong the course of amyloid nephropathy, slowing the onset of chronic renal failure. The main cause of death in patients with AA-type amyloidosis is renal failure.
Amyloid nephropathy, like amyloidosis in general, has a progressive course. During its natural evolution in patients with AA-type amyloidosis, the duration of the proteinuric stage is on average 3-4 years, the stage of nephrotic syndrome - 2.5 years and the stage of chronic renal failure - 1-2 years. The prognosis of renal amyloidosis compared to other glomerular diseases, including diabetic nephropathy, is considered the worst, with the exception of only rapidly progressing glomerulonephritis.
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