Prognostic factors of poor renal outcomes in renal amyloidosis patients: Systematic review and meta-analysis

https://doi.org/10.18535/ijsrm/v7i1.mp01
Prognostic factors, Renal amyloidosis, Meta-analysis, Renal outcomes

Authors

  • Mercy Julian Mwamunyi Department of Nephrology, Union Hospital, Huazhong University of Science & Technology, Jiefang Road 1277, Wuhan, Hubei, 430022, P.R.China, China
  • Huiling Xiang Department of Nephrology, Union Hospital, Huazhong University of Science & Technology, Jiefang Road 1277, Wuhan, Hubei, 430022, P.R.China, China
  • Li-jun Yao Department of Nephrology, Union Hospital, Huazhong University of Science & Technology, Jiefang Road 1277, Wuhan, Hubei, 430022, P.R.China, China
Vol. 7 No. 01 (2019)
Medical Sciences and Pharmacy
January 3, 2019

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Background:Renal involvement by systemic amyloidosis is one of the most common poor outcomes of the disease, usually manifested as nephrotic range proteinuria and can progress to end-stage renal disease (ESRD) with negative effects on the quality of life and survival of the patients. The objective of this meta-analysis was to determine prognostic factors of poor renal outcome in renal amyloidosis patients. The findings of this study may provide a clearer indication of the possibility of worsening state of renal function, which affect monitoring and therapeutic decisions.

Methods:We searched for studies reporting on the renal outcomes in systemic amyloidosis, and cohort studies related to systemic amyloidosis prognosis and/or outcomes.Pooled mean differences, odds ratios and 95% confidence intervals were computed using random-effect approach in Rev Man5.3®. Clinical, laboratory and renal biopsy prognostic factors were tested for heterogeneity and for overall effect. P-value <0.05 was considered statistically significant.

Results: Our search resulted in 7 eligible articles involving 3016 participants in total. Five prospective cohort studies were included. 861 patients had poor renal functional outcomes which included deteriorating estimated glomerular filtration rate, progressing to chronic kidney disease or end-stage renal disease and ESRD-related mortality. Male gender AL (OR 1.58; 95% CI 0.16,15.52, p=0.70) and AA (OR 1.36; 95% CI 0.09, 20.71, p=0.81), proteinuria (OR 1.03; 95% CI 0.40-1.66), serum creatinine (OR1.23; 95%CI 0.65-1.80), eGFR for AA (OR 0.42; 95% CI 0.24-0.72) and eGFR for AL(OR 0.33; 95% CI 0.12-0.91) were poor prognostic factors renal amyloidosis. There were insufficient data to systematically assess age a poor outcome.

Conclusion:The odds of having poor renal prognosis was increased in the male gender, the presence of proteinuria, elevated serum creatinine and decreased eGFR filtration rate. These results highlight the role of aggressive control of modifiable factors like proteinuria, the role of close medical monitoring of patients, that present with fatigue, edema, hypotension, and nephrotic syndrome. These clinical features are strongly associated with renal amyloidosis. Such patients should have a renal biopsy as soon as possible thus to minimize the risk of irreversible kidney damage that adversely affects the renal outcomes.