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Amyloidosis and kidney damage: prognosis
Last reviewed: 23.04.2024
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Amyloidosis is characterized by a steadily progressing 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 most serious. According to the Mayo Clinic, the average life expectancy of patients with this type of amyloidosis is only 13.2 months, a 5-year survival rate of 7%, a 10-year survival rate of only 1%. The lowest life-span was observed in patients with congestive circulatory failure (6 months) and orthostatic arterial hypotension (8 months). The life expectancy of patients with nephrotic syndrome is an average of 16 months. In the presence of myeloma, the prognosis of AL-type amyloidosis worsens, the life expectancy of patients is shortened (5 months). The most frequent causes of death of patients with AL-type amyloidosis are heart failure and heart rhythm disorders (48%), uremia (15%), sepsis and infection (8%). Despite the fact that death from uremia is noted much less often than from cardiac causes, chronic renal failure of varying severity is recorded in more than 60% of the deceased.
With AA-type amyloidosis, the prognosis is more favorable, depends 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 verification of diagnosis is 30-60 months (more with secondary amyloidosis, less with amyloidosis as part of a recurrent disease). Effective treatment of predisposing diseases, including the 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 insufficiency.
Amyloid nephropathy, like amyloidosis in general, has a progressive course. With 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 indroma is 2.5 years and the stage of chronic renal failure is 1-2 years. The prognosis of kidney amyloidosis compared with other glomerular diseases, including those with diabetic nephropathy, is considered the worst, except for the rapidly progressive glomerulonephritis.
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