Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis

Jarosław Sak 1, 2,  
Department of Nephrology, Medical University of Lublin, Lublin, Poland
Department of Ethics and Human Philosophy, Medical University of Lublin, Lublin, Poland
Department of Internal Medicine, Medical University of Lublin, Lublin, Poland
JPCCR 2017;11(1):22–24
Amyloidosis, both primary and secondary, is a systemic disease characterized by extracellular deposition of fibrillar protein in vital organs, leading to their injury and even insufficiency. It results in a poor diagnosis, especially for patients with primary amyloidosis. Kidney involvement is typical and usually manifests by proteinuria, mainly nephrotic range, leading to end-stage renal disease (ESRD). Patients with ESRD need renal replacement therapy (RRT). Some data claim that better results and longer patient, survival are observed in peritoneal dialysed rather than in haemodialysed patients.

Case report:
The case is described of 19-year-old Caucasian woman with primary amyloidosis. Inherited primary amyloidosis with abnormal apolipoprotein A-I was established. The patient was successfully treated with peritoneal dialysis for 87 months. After this period, she was transferred for haemodialysis. Such a long survival time on peritoneal dialysis (PD) in a patient with primary amyloidosis has not been found. It is believed that the lowering of immunoglobulin levels in blood and normalization of total protein in serum effectively removed, through dialysate, the pathological polyclonal proteins. This effect probably also sustained cardio-circulatory sufficiency of the patient and significantly prolonged her survival.

Peritoneal dialysis is an effective and recommended method of treatment in patients suffering from primary amyloidosis. Peritoneal dialysis should be the first choice therapy in ESRD patient; contrary to haemodialysis, peritoneal dialysis removes pathological proteins and allows the avoidance of intra-dialytic hypotension.

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