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Renal Infarction and Its Consequences for Renal Function in Patients With Cardiac Amyloidosis
Julien Dang1, Mukedaisi Abulizi2, Anissa Moktefi3
1Assistance Publique des Hôpitaux de ParisService de Néphrologie et Transplantation, Créteil, 94000, France; Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique de l'Enfant et de l'Adulte, Créteil, 94000, France; Réseau Amylose Mondor, Groupe de Recherche Clinique sur les Amyloses Amyloid Research Institute, Centre de référence des amyloses cardiaques, Université Paris Est Créteil, France; Groupe Hospitalier Henri-Mondor/Albert Chenevier, Université Paris Est Créteil, France; and Equipe 21, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, France.
Insights
Renal infarction (RI) is more common in cardiac amyloidosis patients than previously believed, irrespective of amyloidosis type. Acute kidney injury in these patients may indicate renal infarction.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Cardiac amyloidosis is a progressive condition affecting the heart.
- Renal involvement is a known complication of cardiac amyloidosis.
- The prevalence and risk factors for renal infarction in this population require further elucidation.
Purpose of the Study:
- To determine the prevalence of renal infarction (RI) in patients with cardiac amyloidosis.
- To identify risk factors associated with RI in this patient cohort.
- To assess the impact of RI on renal survival in cardiac amyloidosis.
Main Methods:
- Retrospective analysis of 87 patients with cardiac amyloidosis.
- Renal technetium-99m-labeled dimercaptosuccinic acid scintigraphy was performed.
- Patients were categorized by amyloidosis type: AL, mutated-transthyretin, and wild-type transthyretin.
Main Results:
- Renal infarction was detected in 20.7% of patients, with similar frequencies across amyloidosis types.
- Higher baseline urinary protein to creatinine ratio was associated with RI.
- Acute kidney injury (AKI) significantly increased the likelihood of RI diagnosis (47.1% vs 14.5%).
- Renal survival was significantly lower in patients with RI.
Conclusions:
- The prevalence of renal infarction in cardiac amyloidosis is higher than previously recognized.
- Acute kidney injury should prompt consideration of renal infarction in cardiac amyloidosis patients.
- Renal infarction adversely affects renal outcomes in cardiac amyloidosis.
Objective:
To describe the prevalence of and risk factors for renal infarction (RI) in patients with cardiac amyloidosis.
Patients And Methods:
We evaluated 87 patients with cardiac amyloidosis who underwent renal technetium-99m-labeled dimercaptosuccinic acid scintigraphy in the Amyloidosis Referral Center of Henri-Mondor Hospital from October 1, 2015, through February 28, 2018.
Results:
Three groups of patients were identified according to the underlying amyloidosis disorder: AL amyloidosis in 24 patients, mutated-transthyretin amyloidosis in 24 patients, and wild-type transthyretin amyloidosis in 39 patients. Patients with wild-type transthyretin amyloidosis were older (P<.001), more likely to be men (P=.02), to have arrhythmic heart diseases (P<.001), and to be receiving anticoagulation treatment (P<.001). Patients with AL amyloidosis had significantly higher N-terminal pro-B-type natriuretic peptide levels (P=.02) and were more likely to have nephrotic syndrome (P<.001). Renal infarction was detected in 18 patients (20.7%), at similar frequencies in the various groups. Baseline urinary protein to creatinine ratio was the only parameter for which a significant difference (P=.03) was found between patients with and without RI diagnoses. The likelihood of RI diagnosis was 47.1% (8 of 17) in the presence of AKI and 14.5% (10 of 69) in its absence (P=.003). Overall, heart transplant-censored patient survival did not differ significantly between patients with and without RI (P=.64), but death- and heart transplant-censored renal survival was significantly lower in patients with RI (P<.001).
Conclusion:
Our study suggests that prevalence of RI in patients with cardiac amyloidosis is higher than previously thought, regardless of the underlying amyloidosis disorder. Acute kidney injury in a patient with cardiac amyloidosis should alert clinicians to the possibility of RI.
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