nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/1680-4422-2017-2-315-321nid-375Research ArticleШКОЛА НЕФРОЛОГАEDUCATIONAL MATERIALSАА-амилоидоз у больного гранулематозом с полиангиитом (Вегенера)AA-amyloidosis in patient, suffering from granulomatosis with polyangiitis (Wegener)ФроловаН. Ф.FrolovaN. F.noemail@neicon.ruРамеевВ. В.RameevV. V.noemail@neicon.ruРаденска-ЛоповокС. Г.Radenska-LopovokS. G.noemail@neicon.ruЧервинкоВ. И.ChervinkoV. I.noemail@neicon.ruСтепановаЕ. А.StepanovaE. A.noemail@neicon.ruКалининД. В.KalininD. V.noemail@neicon.ruСтоляревичЕ. С.StolyarevichE. S.noemail@neicon.ruРусейкинаО. М.RuseikinaO. M.noemail@neicon.ruЛогуновО. В.LogunovO. V.noemail@neicon.ruЗубкинМ. Л.ZubkinM. L.m-zubkin@yandex.ruГородская клиническая больница № 52 Департамента здравоохранения города МосквыРоссияMoscow City Clinical Hospital № 52, Healthcare Department of MoscowRussian FederationПервый Московский медицинский университет им. И.М. Сеченова Министерства Здравоохранения Российской ФедерацииРоссияSechenov First Moscow State Medical UniversityRussian FederationГородская клиническая больница имени В.М. Буянова Департамента Здравоохранения города МосквыРоссияBuyanov Moscow City Clinical Hospital Healthcare Department of MoscowRussian FederationФилиал Военно-медицинской академии им. С.М. КироваРоссияThe Branch of the S.M.Kirov Military Medical AcademyRussian FederationИнститут хирургии им. А.В. Вишневского Минздрава РоссииРоссияA.V.Vishnevsky Institute of SurgeryRussian FederationМосковский НИИ эпидемиологии и микробиологии им. Г.Н. Габричевского РоспотребнадзораРоссияG. N. Gabrichevsky Research Institute for Epidemiology and MicrobiologyRussian FederationГородская клиническая больница № 52 Департамента здравоохранения города Москвы; Филиал Военно-медицинской академии им. С.М. Кирова; Московский НИИ эпидемиологии и микробиологии им. Г.Н. Габричевского РоспотребнадзораРоссияMoscow City Clinical Hospital № 52, Healthcare Department of Moscow; The Branch of the S.M.Kirov Military Medical Academy; G. N. Gabrichevsky Research Institute for Epidemiology and MicrobiologyRussian Federation201715082024192315321Copyright © Фролова Н.Ф., Рамеев В.В., Раденска-Лоповок С.Г., Червинко В.И., Степанова Е.А., Калинин Д.В., Столяревич Е.С., Русейкина О.М., Логунов О.В., Зубкин М.Л., 20242024Фролова Н.Ф., Рамеев В.В., Раденска-Лоповок С.Г., Червинко В.И., Степанова Е.А., Калинин Д.В., Столяревич Е.С., Русейкина О.М., Логунов О.В., Зубкин М.Л.Frolova N.F., Rameev V.V., Radenska-Lopovok S.G., Chervinko V.I., Stepanova E.A., Kalinin D.V., Stolyarevich E.S., Ruseikina O.M., Logunov O.V., Zubkin M.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/375

ANCA-ассоциированные васкулиты являются ярко выраженными воспалительными заболеваниями, однако в зарубежной литературе имеются сообщения лишь о единичных случаях диагностики АА-амилоидоза при микроскопическом полиангиите и эозинофильном гранулематозе с полиангиитом (Чарга-Стросса). В настоящем сообщении впервые представлено наблюдение, свидетельствующее о развитии АА-амилоидоза у пожилого мужчины, страдавшего гранулематозом с полиангиитом (Вегенера). Поражение почек характеризовалось развитием pauci-иммунного полулунного гломерулонефрита с быстропрогрессирующим течением. После курса индукционной терапии была достигнута полная клинико-иммунологическая ремиссия заболевания, которая сохранялась на фоне поддерживающей терапии. Редкие проявления слабой активности васкулита практически не влияли на состояние почечной функции. Летальный исход развился в результате полиорганной недостаточности на фоне септических осложнений острой пневмонии. Клинические проявления системного амилоидоза отсутствовали. АА-амилоидоз был диагностирован при посмертном морфологическом исследовании и с высокой долей вероятности оказался следствием основного заболевания.

Despite the fact that ANCA-associated vasculitis are pronounced inflammatory diseases, there are only few reports of cases of diagnosis of AA-amyloidosis in microscopic polyangiitis and the eosinophilic granulomatosis with polyangiitis (Churg-Strauss) in foreign literature. In this article we for the first time present evidence for the development of AA-amyloidosis in an elderly man, suffering from granulomatosis with polyangiitis (Wegener). Renal disease was characterized by the development of crescent pauci-immune glomerulonephritis with rapidly progressive course. After a course of induction therapy complete clinical and immunological remission was achieved, which persisted on the background of maintenance therapy. Rare manifestations of a weak activity of vasculitis almost did not affect the renal function. Death has developed as a result of multiple organ failure on the background of the septic complications of acute pneumonia. Clinical manifestations of systemic amyloidosis were absent. AA-amyloidosis was diagnosed by post-mortem morphological study and with high probability was a result of the underlying disease.

АА-амилоидозANCA-ассоциированные васкулитыгранулематоз с полиангиитом (Вегенера)AA-amyloidosisthe ANCA-associated vasculitisgranulomatosis with polyangiitis (Wegener&aposs)ReferencesБекетова Т.В. АНЦА-ассоциированные системные васкулиты. Под редакцией академика РАН Насонова Е.Л. 2015. 46 с.Бекетова Т.В. АНЦА-ассоциированные системные васкулиты. Под редакцией академика РАН Насонова Е.Л. 2015. 46 с.Рамеев В.В., Козловская Л.В. Современные подходы к лечению амилиодоза. Современная медицинская наука. 2012. 1: 4-15.Рамеев В.В., Козловская Л.В. Современные подходы к лечению амилиодоза. Современная медицинская наука. 2012. 1: 4-15.Тареев Е.М. Нефриты. Государственное издательство медицинской литературы. Москва, 1958. 668 с.Тареев Е.М. Нефриты. Государственное издательство медицинской литературы. Москва, 1958. 668 с.Daha M.R., Falk R.J. Anti-myeloperoxidase antibodiesand clinical associations. Neth J Med. 1990. 36: 152-153.Daha M.R., Falk R.J. Anti-myeloperoxidase antibodiesand clinical associations. Neth J Med. 1990. 36: 152-153.Espinosa M., Rodriguez M., Martin-Malo A. et al. A case of Takayasu’s arteritis, nephrotic syndrome, and systemic amyloidosis. Nephrol Dial Transplant. 1994. 9: 1486-1488.Espinosa M., Rodriguez M., Martin-Malo A. et al. A case of Takayasu’s arteritis, nephrotic syndrome, and systemic amyloidosis. Nephrol Dial Transplant. 1994. 9: 1486-1488.Fauci A.S., Haynes B.F., Katz P., Wolff S.M. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med. 1983. 98: 76-85.Fauci A.S., Haynes B.F., Katz P., Wolff S.M. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med. 1983. 98: 76-85.Fujimoto S., Watts R., Kobayashi S. et al. Comparison of the epidemiology of anti-neutrophil cytoplasmic antibodyassociated vasculitis between Japan and the UK. Rheumatology. 2011. 50: 1916-1920.Fujimoto S., Watts R., Kobayashi S. et al. Comparison of the epidemiology of anti-neutrophil cytoplasmic antibodyassociated vasculitis between Japan and the UK. Rheumatology. 2011. 50: 1916-1920.Hagen E.C., Daha M.R., Hermans J. et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis: EC/BCR Project for ANCA Assay Standardization. Kidney Int. 1998. 53: 743-753.Hagen E.C., Daha M.R., Hermans J. et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis: EC/BCR Project for ANCA Assay Standardization. Kidney Int. 1998. 53: 743-753.Haugeberg G., Bie R., Bendvold A. et al. Primary vasculitis in a Norwegian community hospital: a retrospective study. Clin Rheumatol. 1998. 17: 364-368.Haugeberg G., Bie R., Bendvold A. et al. Primary vasculitis in a Norwegian community hospital: a retrospective study. Clin Rheumatol. 1998. 17: 364-368.Hoffman G.S., Kerr G.S., Leavitt R.Y. et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992. 116: 488-498.Hoffman G.S., Kerr G.S., Leavitt R.Y. et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992. 116: 488-498.Jennette J.C. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin Exp Nephrol. 2013. 17(5): 603-606.Jennette J.C. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin Exp Nephrol. 2013. 17(5): 603-606.Jennette J.C. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003. 63(3) :1164-1167.Jennette J.C. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003. 63(3) :1164-1167.Joss N., McLaughlin K., Simpson K., Boulton-Jones JM. Presentation, survival and prognostic markers in AA-amyloidosis. Quart J Med. 2000. 93(8): 535-542.Joss N., McLaughlin K., Simpson K., Boulton-Jones JM. Presentation, survival and prognostic markers in AA-amyloidosis. Quart J Med. 2000. 93(8): 535-542.Lachmann H.J., Goodman H.J., Gilbertson J.A. et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007. 356: 2361-2371.Lachmann H.J., Goodman H.J., Gilbertson J.A. et al. Natural history and outcome in systemic AA amyloidosis. N Engl J Med. 2007. 356: 2361-2371.Leavitt R.Y., Fauci A.S., Bloch D.A. et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum. 1990. 33: 1101-1107.Leavitt R.Y., Fauci A.S., Bloch D.A. et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum. 1990. 33: 1101-1107.Lhote F., Guillevin L. Polyarteritisnodosa, microscopicpolyangiitis, and Churg-Strausssyndrome. Clinical aspects and treatment. Rheum Dis Clin North Am. 1995. 21: 911-947.Lhote F., Guillevin L. Polyarteritisnodosa, microscopicpolyangiitis, and Churg-Strausssyndrome. Clinical aspects and treatment. Rheum Dis Clin North Am. 1995. 21: 911-947.Lyons P.A., Rayner T.F., Trivedi S. et al. Genetically Distinct Subsets within ANCA-Associated Vasculitis. N Engl J Med. 2012. 367: 214-223.Lyons P.A., Rayner T.F., Trivedi S. et al. Genetically Distinct Subsets within ANCA-Associated Vasculitis. N Engl J Med. 2012. 367: 214-223.Maamar M., Tazi-Mezalek Z., Harmouche H. et al. Churg-Strauss syndrome associated with AA amyloidosis: a case report. The Pan African Medical Journal. 2012. 12:30. Published online 2012 Jun 11.Maamar M., Tazi-Mezalek Z., Harmouche H. et al. Churg-Strauss syndrome associated with AA amyloidosis: a case report. The Pan African Medical Journal. 2012. 12:30. Published online 2012 Jun 11.Mahr A., Katsahian S., Varet H. et al. Revisiting the classification of clinical phenotypes of anti-neutrophil cytoplasmic antibody-associated vasculitis: a cluster analysis. Ann Rheum Dis. 2013. 72: 1003-1010.Mahr A., Katsahian S., Varet H. et al. Revisiting the classification of clinical phenotypes of anti-neutrophil cytoplasmic antibody-associated vasculitis: a cluster analysis. Ann Rheum Dis. 2013. 72: 1003-1010.Makino H., Nagake Y., Murakami K. et al. Remission of nephrotic syndrome in a patient with renal amyloidosis associated with Takayasu’s arteritis after treatment with dimethylsulphoxide. Ann Rheum Dis. 1994. 53: 842-843.Makino H., Nagake Y., Murakami K. et al. Remission of nephrotic syndrome in a patient with renal amyloidosis associated with Takayasu’s arteritis after treatment with dimethylsulphoxide. Ann Rheum Dis. 1994. 53: 842-843.Monteagudo M., Vidal G., Andreu J. et al. Giant cell (temporal) arteritis and secondary renal amyloidosis: report of 2 cases. J Rheumatol. 1997. 24: 605-607.Monteagudo M., Vidal G., Andreu J. et al. Giant cell (temporal) arteritis and secondary renal amyloidosis: report of 2 cases. J Rheumatol. 1997. 24: 605-607.Nachman P.H., Reisner H.M., Yang J.J. et al. Shared idiotypy among patients with myeloperoxidase-anti-neutrophil cytoplasmic autoantibody associated glomerulonephritis and vasculitis. Lab Invest. 1996. 74: 519-527.Nachman P.H., Reisner H.M., Yang J.J. et al. Shared idiotypy among patients with myeloperoxidase-anti-neutrophil cytoplasmic autoantibody associated glomerulonephritis and vasculitis. Lab Invest. 1996. 74: 519-527.Nienhuis H.L., Bijzet J., Hazenberg B.P. The Prevalence and Management of Systemic Amyloidosis in Western Countries. Kidney Dis (Basel). 2016. 2(1): 10-9.Nienhuis H.L., Bijzet J., Hazenberg B.P. The Prevalence and Management of Systemic Amyloidosis in Western Countries. Kidney Dis (Basel). 2016. 2(1): 10-9.Obici L., Raimondi S., Lavatelli F. et al. Susceptibility to AA amyloidosis in rheumatic diseases: a critical overview. Arthritis Rheum. 2009. 61: 1435-1440.Obici L., Raimondi S., Lavatelli F. et al. Susceptibility to AA amyloidosis in rheumatic diseases: a critical overview. Arthritis Rheum. 2009. 61: 1435-1440.Savage C.O., Winearls C.G., Evans D.J. et al. Microscopicpolyarteritis: presentation, pathologyand prognosis. Q J Med. 1985. 56: 467-483.Savage C.O., Winearls C.G., Evans D.J. et al. Microscopicpolyarteritis: presentation, pathologyand prognosis. Q J Med. 1985. 56: 467-483.Ubara Y., Tagami T., Suwabe T. et al. Systemic AA-amyloidosis related to MPO-ANCA-microscopicpolyangiitis: Acasereport. Amyloid. 2006. 13(3): 178-183.Ubara Y., Tagami T., Suwabe T. et al. Systemic AA-amyloidosis related to MPO-ANCA-microscopicpolyangiitis: Acasereport. Amyloid. 2006. 13(3): 178-183.Uhlar C.M., Whitehead A.S. Serum amyloid A, the major vertebrate acute phase reactant. Eur J Biochem. 1999. 265: 501-523.Uhlar C.M., Whitehead A.S. Serum amyloid A, the major vertebrate acute phase reactant. Eur J Biochem. 1999. 265: 501-523.Urieli-Shoval S., Linke R.P., Matzner Y. Expression and function of serum amyloid A, a major acute-phase protein, in normal and disease states. Curr Opin Hematol. 2000. 7: 64-69.Urieli-Shoval S., Linke R.P., Matzner Y. Expression and function of serum amyloid A, a major acute-phase protein, in normal and disease states. Curr Opin Hematol. 2000. 7: 64-69.Van der Meulen J., Gupta R.K., Peregrin J.H. et al. Takayasu’s arteritis and nephrotic syndrome in a patient with crossed renal ectopia. Neth J Med. 1989. 34: 142-147.Van der Meulen J., Gupta R.K., Peregrin J.H. et al. Takayasu’s arteritis and nephrotic syndrome in a patient with crossed renal ectopia. Neth J Med. 1989. 34: 142-147.Wada Y., Nishida H., Kohno K. et al. AA amyloidosis in Takayasu’s arteritis-long-term survival on maintenance hemodialysis. Nephrol Dial Transplant. 1999. 14: 2478-2481.Wada Y., Nishida H., Kohno K. et al. AA amyloidosis in Takayasu’s arteritis-long-term survival on maintenance hemodialysis. Nephrol Dial Transplant. 1999. 14: 2478-2481.Watts R.A., Lane S.E., Bentham G. et al: Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum. 2000. 43: 414-419.Watts R.A., Lane S.E., Bentham G. et al: Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum. 2000. 43: 414-419.Watts R.A., Mahr A., Mohammad A.J. et al. Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant. 2015. 30(1): 14-22.Watts R.A., Mahr A., Mohammad A.J. et al. Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant. 2015. 30(1): 14-22.

The authors declare that there are no conflicts of interest present.