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==Overview==
==Overview==


The mainstay of treatment for Renal amyloidosis is to decrease the production of amyloid.
The mainstay of treatment for renal amyloidosis is to decrease the production or increase clearing of [[amyloid]]. Pharmacologic medical therapies for renal amyloidosis include [[colchicine]], [[azathioprine]], [[dimethylsulfoxide]], [[chlorambucil]], [[methotrexate]], [[cyclophosphamide]], and TNF-alpha antagonists (ie, [[etanercept]], [[infliximab]], and [[adalimumab]]).  


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapies for [[Renal amyloidosis]] include Colchicine  Dimethylsulfoxide   Azathioprine  Chlorambucil Methotrexate Cyclophosphamide TNF-alpha antagonists (ie, etanercept, infliximab, and adalimumab)
Pharmacologic medical therapies for renal amyloidosis include:
*Proline for clearing amyloid
* [[Colchicine]]  <ref name="pmid1584316">{{cite journal |vauthors=Livneh A, Zemer D, Siegal B, Laor A, Sohar E, Pras M |title=Colchicine prevents kidney transplant amyloidosis in familial Mediterranean fever |journal=Nephron |volume=60 |issue=4 |pages=418–22 |date=1992 |pmid=1584316 |doi=10.1159/000186801 |url=}}</ref><ref name="pmid14978665">{{cite journal |vauthors=Lidar M, Scherrmann JM, Shinar Y, Chetrit A, Niel E, Gershoni-Baruch R, Langevitz P, Livneh A |title=Colchicine nonresponsiveness in familial Mediterranean fever: clinical, genetic, pharmacokinetic, and socioeconomic characterization |journal=Semin. Arthritis Rheum. |volume=33 |issue=4 |pages=273–82 |date=February 2004 |pmid=14978665 |doi= |url=}}</ref><ref name="pmid7780053">{{cite journal |vauthors=Tan AU, Cohen AH, Levine BS |title=Renal amyloidosis in a drug abuser |journal=J. Am. Soc. Nephrol. |volume=5 |issue=9 |pages=1653–8 |date=March 1995 |pmid=7780053 |doi= |url=}}</ref>
===Disease Name===
* [[Azathioprine]]  
* [[Dimethyl sulfoxide|Dimethylsulfoxide]]<ref name="pmid10576978">{{cite journal |vauthors=Iwakiri R, Sakemi T, Fujimoto K |title=Dimethylsulfoxide for renal dysfunction caused by systemic amyloidosis complicating Crohn's disease |journal=Gastroenterology |volume=117 |issue=4 |pages=1031–2 |date=October 1999 |pmid=10576978 |doi= |url=}}</ref><ref name="pmid16799886">{{cite journal |vauthors=Amemori S, Iwakiri R, Endo H, Ootani A, Ogata S, Noda T, Tsunada S, Sakata H, Matsunaga H, Mizuguchi M, Ikeda Y, Fujimoto K |title=Oral dimethyl sulfoxide for systemic amyloid A amyloidosis complication in chronic inflammatory disease: a retrospective patient chart review |journal=J. Gastroenterol. |volume=41 |issue=5 |pages=444–9 |date=May 2006 |pmid=16799886 |doi=10.1007/s00535-006-1792-3 |url=}}</ref>
* [[Chlorambucil]]
* [[Methotrexate]]
* [[Cyclophosphamide]] <ref name="pmid11477289">{{cite journal |vauthors=Chevrel G, Jenvrin C, McGregor B, Miossec P |title=Renal type AA amyloidosis associated with rheumatoid arthritis: a cohort study showing improved survival on treatment with pulse cyclophosphamide |journal=Rheumatology (Oxford) |volume=40 |issue=7 |pages=821–5 |date=July 2001 |pmid=11477289 |doi= |url=}}</ref><ref name="pmid14677008">{{cite journal |vauthors=Nakamura T, Yamamura Y, Tomoda K, Tsukano M, Shono M, Baba S |title=Efficacy of cyclophosphamide combined with prednisolone in patients with AA amyloidosis secondary to rheumatoid arthritis |journal=Clin. Rheumatol. |volume=22 |issue=6 |pages=371–5 |date=December 2003 |pmid=14677008 |doi=10.1007/s10067-003-0763-9 |url=}}</ref>
* TNF-alpha antagonists (ie, [[etanercept]], [[infliximab]], and [[adalimumab]])<ref name="pmid12847696">{{cite journal |vauthors=Gottenberg JE, Merle-Vincent F, Bentaberry F, Allanore Y, Berenbaum F, Fautrel B, Combe B, Durbach A, Sibilia J, Dougados M, Mariette X |title=Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy |journal=Arthritis Rheum. |volume=48 |issue=7 |pages=2019–24 |date=July 2003 |pmid=12847696 |doi=10.1002/art.11163 |url=}}</ref><ref name="pmid15866260">{{cite journal |vauthors=Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, Castro MC, Olivé A, de Haro M, Portales RG, García-Vicuña R, González-Mari MV, Laffón A, García-Vicuña R |title=Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists |journal=Am. J. Med. |volume=118 |issue=5 |pages=552–6 |date=May 2005 |pmid=15866260 |doi=10.1016/j.amjmed.2005.01.028 |url=}}</ref><ref name="pmid20440529">{{cite journal |vauthors=Nakamura T, Higashi S, Tomoda K, Tsukano M, Shono M |title=Etanercept can induce resolution of renal deterioration in patients with amyloid A amyloidosis secondary to rheumatoid arthritis |journal=Clin. Rheumatol. |volume=29 |issue=12 |pages=1395–401 |date=December 2010 |pmid=20440529 |doi=10.1007/s10067-010-1469-4 |url=}}</ref><ref name="pmid19366896">{{cite journal |vauthors=Keersmaekers T, Claes K, Kuypers DR, de Vlam K, Verschueren P, Westhovens R |title=Long-term efficacy of infliximab treatment for AA-amyloidosis secondary to chronic inflammatory arthritis |journal=Ann. Rheum. Dis. |volume=68 |issue=5 |pages=759–61 |date=May 2009 |pmid=19366896 |doi=10.1136/ard.2008.095505 |url=}}</ref>


* '''1 Stage 1 - Name of stage'''
*[[Proline]] for clearing amyloid <ref name="pmid12015594">{{cite journal |vauthors=Pepys MB, Herbert J, Hutchinson WL, Tennent GA, Lachmann HJ, Gallimore JR, Lovat LB, Bartfai T, Alanine A, Hertel C, Hoffmann T, Jakob-Roetne R, Norcross RD, Kemp JA, Yamamura K, Suzuki M, Taylor GW, Murray S, Thompson D, Purvis A, Kolstoe S, Wood SP, Hawkins PN |title=Targeted pharmacological depletion of serum amyloid P component for treatment of human amyloidosis |journal=Nature |volume=417 |issue=6886 |pages=254–9 |date=May 2002 |pmid=12015594 |doi=10.1038/417254a |url=}}</ref><ref name="pmid20064157">{{cite journal |vauthors=Gillmore JD, Tennent GA, Hutchinson WL, Gallimore JR, Lachmann HJ, Goodman HJ, Offer M, Millar DJ, Petrie A, Hawkins PN, Pepys MB |title=Sustained pharmacological depletion of serum amyloid P component in patients with systemic amyloidosis |journal=Br. J. Haematol. |volume=148 |issue=5 |pages=760–7 |date=March 2010 |pmid=20064157 |doi=10.1111/j.1365-2141.2009.08036.x |url=}}</ref>
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 20:54, 1 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2] Omer Kamal, M.D. [2]

Overview

The mainstay of treatment for renal amyloidosis is to decrease the production or increase clearing of amyloid. Pharmacologic medical therapies for renal amyloidosis include colchicine, azathioprine, dimethylsulfoxide, chlorambucil, methotrexate, cyclophosphamide, and TNF-alpha antagonists (ie, etanercept, infliximab, and adalimumab).

Medical Therapy

Pharmacologic medical therapies for renal amyloidosis include:

References

  1. ↑ Livneh A, Zemer D, Siegal B, Laor A, Sohar E, Pras M (1992). "Colchicine prevents kidney transplant amyloidosis in familial Mediterranean fever". Nephron. 60 (4): 418–22. doi:10.1159/000186801. PMID 1584316.
  2. ↑ Lidar M, Scherrmann JM, Shinar Y, Chetrit A, Niel E, Gershoni-Baruch R, Langevitz P, Livneh A (February 2004). "Colchicine nonresponsiveness in familial Mediterranean fever: clinical, genetic, pharmacokinetic, and socioeconomic characterization". Semin. Arthritis Rheum. 33 (4): 273–82. PMID 14978665.
  3. ↑ Tan AU, Cohen AH, Levine BS (March 1995). "Renal amyloidosis in a drug abuser". J. Am. Soc. Nephrol. 5 (9): 1653–8. PMID 7780053.
  4. ↑ Iwakiri R, Sakemi T, Fujimoto K (October 1999). "Dimethylsulfoxide for renal dysfunction caused by systemic amyloidosis complicating Crohn's disease". Gastroenterology. 117 (4): 1031–2. PMID 10576978.
  5. ↑ Amemori S, Iwakiri R, Endo H, Ootani A, Ogata S, Noda T, Tsunada S, Sakata H, Matsunaga H, Mizuguchi M, Ikeda Y, Fujimoto K (May 2006). "Oral dimethyl sulfoxide for systemic amyloid A amyloidosis complication in chronic inflammatory disease: a retrospective patient chart review". J. Gastroenterol. 41 (5): 444–9. doi:10.1007/s00535-006-1792-3. PMID 16799886.
  6. ↑ Chevrel G, Jenvrin C, McGregor B, Miossec P (July 2001). "Renal type AA amyloidosis associated with rheumatoid arthritis: a cohort study showing improved survival on treatment with pulse cyclophosphamide". Rheumatology (Oxford). 40 (7): 821–5. PMID 11477289.
  7. ↑ Nakamura T, Yamamura Y, Tomoda K, Tsukano M, Shono M, Baba S (December 2003). "Efficacy of cyclophosphamide combined with prednisolone in patients with AA amyloidosis secondary to rheumatoid arthritis". Clin. Rheumatol. 22 (6): 371–5. doi:10.1007/s10067-003-0763-9. PMID 14677008.
  8. ↑ Gottenberg JE, Merle-Vincent F, Bentaberry F, Allanore Y, Berenbaum F, Fautrel B, Combe B, Durbach A, Sibilia J, Dougados M, Mariette X (July 2003). "Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy". Arthritis Rheum. 48 (7): 2019–24. doi:10.1002/art.11163. PMID 12847696.
  9. ↑ Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, Castro MC, Olivé A, de Haro M, Portales RG, García-Vicuña R, González-Mari MV, Laffón A, García-Vicuña R (May 2005). "Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists". Am. J. Med. 118 (5): 552–6. doi:10.1016/j.amjmed.2005.01.028. PMID 15866260.
  10. ↑ Nakamura T, Higashi S, Tomoda K, Tsukano M, Shono M (December 2010). "Etanercept can induce resolution of renal deterioration in patients with amyloid A amyloidosis secondary to rheumatoid arthritis". Clin. Rheumatol. 29 (12): 1395–401. doi:10.1007/s10067-010-1469-4. PMID 20440529.
  11. ↑ Keersmaekers T, Claes K, Kuypers DR, de Vlam K, Verschueren P, Westhovens R (May 2009). "Long-term efficacy of infliximab treatment for AA-amyloidosis secondary to chronic inflammatory arthritis". Ann. Rheum. Dis. 68 (5): 759–61. doi:10.1136/ard.2008.095505. PMID 19366896.
  12. ↑ Pepys MB, Herbert J, Hutchinson WL, Tennent GA, Lachmann HJ, Gallimore JR, Lovat LB, Bartfai T, Alanine A, Hertel C, Hoffmann T, Jakob-Roetne R, Norcross RD, Kemp JA, Yamamura K, Suzuki M, Taylor GW, Murray S, Thompson D, Purvis A, Kolstoe S, Wood SP, Hawkins PN (May 2002). "Targeted pharmacological depletion of serum amyloid P component for treatment of human amyloidosis". Nature. 417 (6886): 254–9. doi:10.1038/417254a. PMID 12015594.
  13. ↑ Gillmore JD, Tennent GA, Hutchinson WL, Gallimore JR, Lachmann HJ, Goodman HJ, Offer M, Millar DJ, Petrie A, Hawkins PN, Pepys MB (March 2010). "Sustained pharmacological depletion of serum amyloid P component in patients with systemic amyloidosis". Br. J. Haematol. 148 (5): 760–7. doi:10.1111/j.1365-2141.2009.08036.x. PMID 20064157.

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