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Urinary albumin excretion in patients with familial Mediterranean fever: a pilot study
1Department of Internal Medicine B, Barzilai Medical Center, Ashkelon, Israel.
Abstract:
Amyloidosis of the kidney is the most threatening complication in familial Mediterranean fever (FMF), and colchicine has been shown to reduce its occurrence. In the preclinical stage of kidney amyloidosis, no proteinuria is observed by the standard Albustix method. However, whether these patients have normal or increased urinary albumin excretion is not known. The purpose of this study was to evaluate albumin excretion in FMF patients treated with colchicine and to compare these values to those of a normal control group. Twenty-two subjects with FMF were compared with 16 normal subjects matched with regard to age and body surface area. The two groups did not differ with regard to female/male ratio and arterial pressure. Urine samples were collected overnight while patients were recumbent and in the daytime while they were ambulant. After measuring albumin concentration (Ua) by radio-immunoassay and creatinine concentration through the standard method, the urinary albumin excretion rate (UaV) and urinary albumin creatinine ratio (Ua/c) were calculated. In the FMF group, three patients had microalbuminuria--defined as an albumin excretion rate higher than 20 micrograms/min. Two of them had this condition only in the early morning collection. These three patients were characterized by a longer duration of symptoms (18 vs. 9 years). No patient in the control group had microalbuminuria. The mean UaV in the FMF group did not differ significantly from that of the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Familial Mediterranean fever (FMF) patients on colchicine may have subtle kidney changes. Microalbuminuria, indicating early kidney damage, was found in some FMF patients, suggesting closer monitoring for kidney amyloidosis.
Area of Science:
- Nephrology
- Rheumatology
- Genetics
Background:
- Kidney amyloidosis is a severe complication of familial Mediterranean fever (FMF).
- Colchicine treatment reduces FMF-related kidney amyloidosis occurrence.
- Early kidney amyloidosis may not show proteinuria via standard tests.
Purpose of the Study:
- To assess urinary albumin excretion in FMF patients treated with colchicine.
- To compare albumin excretion in FMF patients with a healthy control group.
- To identify potential early markers for kidney amyloidosis in FMF.
Main Methods:
- Compared 22 FMF patients on colchicine with 16 age/BSA-matched controls.
- Collected overnight recumbent and daytime ambulant urine samples.
- Measured urinary albumin and creatinine via radio-immunoassay and standard methods, calculating UaV and Ua/c.
Main Results:
- Three FMF patients exhibited microalbuminuria (UaV > 20 µg/min), with two showing it only in morning samples.
- Microalbuminuria in FMF patients correlated with longer symptom duration (18 vs. 9 years).
- No control subjects had microalbuminuria; mean UaV did not significantly differ between groups.
Conclusions:
- Subtle albuminuria (microalbuminuria) may be present in FMF patients on colchicine, even without overt proteinuria.
- Early detection of microalbuminuria could aid in monitoring for preclinical kidney amyloidosis in FMF.
- Longer disease duration may be associated with increased risk of microalbuminuria in FMF patients.