Abstract
A 55-year-old woman with symptoms of fever and arthritis was diagnosed as having rheumatoid arthritis twenty years ago. After a period of two or three years without any treatment, renal failure with mild proteinuria was discovered when she began to complain of pain in her knee joint. Before the start of hemodialysis therapy, an open renal biopsy was performed to investigate the pathogenesis of rapidly progressive renal failure (serum creatinine level was 9mg/dl). As a result, amyloid deposits were demonstrated by Congo red staining. Inhibition by KMnO4 treatment strongly suggested that the biochemical type in the present case was amyloid A (AA). Confirming this, AA was localized in the glomeruli and blood vessels by the peroxidase-antiperoxidase (PAP) method, in which rabbit anti-human serum AA antibody was used. No positive staining, however, was found by the same method when rabbit antibodies against amyloidgenic proteins were used, including anti-β2-microg-lobulin, light chain (κ, λ) and amyloid P component antibody, respectively. Slight elevation of serum AA (17μg) and an altered OKT4/OKT8 ratio in peripheral blood lymphocytes may have been pathogenic or pathognomonic in the present case. Moreover, it is possible to prevent several complications (e. g., GI bleeding, etc.), as a result of definitive diagnosis of amyloidosis before the start of hemodialysis therapy.
