Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases

Our plain-English summary of Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases, by R. Shibata, T. Ozaki, K. Tada, et al (CEN Case Reports, 2020).

The study

• Authors: R. Shibata, T. Ozaki, K. Tada, T. Aoyama, M. Watanabe, N. Himuro, K. Takahashi, K. Ito, T. Yasuno, K. Miyake, K. Masutani, N. Uesugi, K. Nabeshima, H. Nakashima
• Journal: CEN Case Reports
• Published: 2020;9(4):385-391
• Type of article: Case report, Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.

In plain English

This case report described a 67-year-old Japanese man who had worked in the construction industry with asbestos exposure for about 8 years, from age 30 to 38. The article did not name the asbestos fiber type. Three years before admission, a checkup found pleural effusion (fluid around the lungs). A pleural biopsy suggested fibrous pleuritis, with no definite evidence of malignant mesothelioma. He was admitted with leg swelling and nephrotic syndrome and was losing 5.5 g of protein in his urine each day. A kidney biopsy showed deposits of AA-type amyloid. A calcified mass in the right lower lung took up gallium tracer on scanning, but lung biopsy and lavage found no cancer. He was diagnosed with rounded atelectasis and diffuse pleural thickening and was given a low-dose angiotensin II receptor blocker. His nephrotic syndrome persisted and his kidney failure progressed. The authors concluded that his amyloidosis was secondary to these benign asbestos-related conditions. They also wrote that any causal relationship between asbestos-related pleural diseases and amyloidosis is unclear.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of a single patient
• Who was studied: one 67-year-old Japanese man admitted to the authors' hospital (Fukuoka University, Japan) with leg edema
• Exposure: occupational asbestos exposure in the construction industry for about 8 years, from age 30 through 38; fiber type not reported; 22 pack-year smoking history
• Main results:
  • Pleural biopsy: homozygous CDKN2A/p16 deletion was found in 7.4% of cells, which suggested fibrous pleuritis rather than mesothelioma
  • The patient's daily urinary protein excretion was 5.5 g
  • The patient's serum amyloid A protein was high at 85.4 μg/mL
  • The kidney biopsy contained 27 glomeruli, of which 11 showed global sclerosis; AA amyloidosis was diagnosed
  • Gallium (67Ga) scintigraphy showed significant uptake in the right lower lung, where CT showed a calcified mass suggestive of rounded atelectasis
  • Lung tissue from transbronchial biopsy showed no ferruginous bodies, silicotic nodules or silica crystals
  • He was treated with a low-dose angiotensin II receptor blocker; his nephrotic syndrome persisted and chronic renal failure progressed
  • The authors reported this as, to their knowledge, the first case of asbestos-related disease presenting with secondary amyloidosis
• The authors' conclusion: The authors concluded that the patient's AA amyloidosis was secondary to asbestos-related rounded atelectasis and diffuse pleural thickening, attributing it to active inflammation in the rounded atelectasis. They also stated that a causal relationship between asbestos-related pleural diseases and amyloidosis is unclear.
• Limitations the authors state:
  • The cause of the inflammation in the rounded atelectasis could not be determined in detail
  • Coexisting asbestosis could not be ruled out, possibly because of sampling error
  • No dipstick urine tests had been done during the 3 years before admission
  • Genetic testing for familial Mediterranean fever was not performed
  • Malignant mesothelioma had not been definitively excluded and requires follow-up

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pleural Effusion, Cytology, Pleural Biopsy, Malignant Mesothelioma, Biopsy, Bronchoalveolar Lavage (BAL), Rounded Atelectasis.

Related studies

• Pleural amyloidosis mimicking mesothelioma: a clinicopathologic study of two cases — A.L. Adams, C.Y. Castro, et al. (2001)
• Nodular pulmonary amyloidosis associated with asbestos exposure — K. Hiroshima, H. Ohwada, et al. (1996)
• Nephrotic syndrome and mesenteric infarction secondary to metastatic mesothelioma — C.K. Farmer, D.J. Goldsmith (2001)
• Asbestos-related pleuropulmonary diseases: evaluation with low-dose four-detector row spiral CT — M. Remy-Jardin, A. Sobaszek, et al. (2004)
• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)
• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)

Browse return to medical research.