Abstract
We report 2 patients with chronic heart and renal failure, resulting from amyloidosis secondary to rheumatoid arthritis (RA), which was well controlled with CAPD.
Case 1 was a 75-year-old woman diagnosed as having RA in 1981. Proteinuria appeared in 1983. Renal function deteriorated in 1987, and became worse in July, 1989. As severe heart failure contraindicating HD was present, CAPD was instituted in Aug. Uremia, edema and the symptoms of heart failure were controlled well. In March, 1990, amyloid deposition was detected by gastric biopsy, around which time the heart failure again became worse and the blood pressure fell. Bradycardia was noted on May 1, and the patient died on May 7. Autopsy revealed marked accumulation of AA-type amyloid in the heart, kidney, thyroid, pancreas, alimentary tract and medium and small arteries all over the body.
Case 2 was a 72-year-old woman diagnosed as having RA in 1982, Proteinuria and renal dysfunction appeared in 1988. In Sep., 1989, AA-type amyloid deposition was detected in biopsies of the small salivary glands and thyroid. Renal function was slightly improved by dimethylsulfoxide (DMSO), but it rapidly deteriorated after the end of Feb., 1990, when the patient rejected DMSO. As severe heart failure contraindicated HD, CAPD was instituted in March. Uremia and heart failure were controlled well. Heart failure again intensified in July, blood pressure fell in Aug., and the patient died on Sep. 12.
Though severe heart failure was present, uremia was well controlled by CAPD in both cases. However, both patients died of aggravated heart failure at 8 months and 6 months respectively after the initiation of CAPD. The chief cause of heart failure seemed to be advanced amyloidosis of the heart. This suggests that the treatment to halt the advance of heart amyloidosis must be continued after the initiation of CAPD.
