AJRI AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY 28:243-244 © 1992 MUNKSGAARD
The Effect of Pregnancy on Renal Function in Amyloidosis of Familial Mediterranean Fever SHALTIEL CABILI, AVI LIVNEH, DEBORAH ZEMER, OSVALDORABINOVITCH, AND MORDECHAI PRAS Heller Institute ofMedical Research and Departments of Medicine and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel ABSTRACT: The effect of pregnancy on kidney function was studied in 29 pregnancies of 17 patients with familial Mediterranean fever (FMF) and amyloidosis. Pregnancy associated deterioration of renal function occurred in seven patients who had advanced renal disease at conception, marked by serum creatinine ~ 1.5 mg/dl or urine protein ~ 2 g/24 h. This finding suggests that the severity of renal disease at conception may predict the fate of kidney function during pregnancy and puerperium. (Am J Reprod Immunol. 1992; 28:243-244.) Key words: Amyloidosis, Familial Mediterranean Fever, kidney, pregnancy INTRODUCTION
Familial Mediterranean fever (FMF) is a genetic disease manifested by recurrent attacks of febrile serositis and the insidious development ofnephropathic AA amyloidosis.' Amyloidosis affects most untreated FMF patients. Its early stage is recognized by the appearance of proteinuria." Continuous colchicine treatment in a dose of 1-2 mg/day was found to prevent attacks in most patients and amyloidosis in all patients." However, amyloidosis is still encountered in uncompliant patients and in those who acquired amyloidosis prior to initiation of colchicine. The objective of this study is to elucidate the effect of pregnancy on renal function in FMF patients with amyloid nephropathy.
TABLE I. Factors That May Determine Kidney Function During Pregnancy or Puerperium Range
Factor studied Age at conception Creatinine at conception Proteinuria at conception Duration of proteinuria Creatinine at delivery
18-37 0.6-3 0.5-8 1-19 0.6-7
years mg/dl g/24h years mg/dl
Mean+SD 27 ± 4.5 years 8.2 ± 5 years
six intermediate. Figs. 1 and 2 show that the divergent outcome of kidney function in the 10 pregnancies with initial kidney disease of intermediate severity does not correlate with, and therefore may not be determined by the extent of daily proteinuria and the duration of overt amyloidosis at conception. Insufficient data on colchicine treatment and low frequency of hypertension (3/29 pregnancies) made their effect impossible to evaluate in the present study. Altogether these data suggest that in FMF amyloid nephropathy, renal function may be compromised in patients with more advanced renal disease at concep-
---...t=
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7
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The Effect of Pregnancy on Renal Function in Amyloidosis of Familial Mediterranean Fever SHALTIEL CABILI, AVI LIVNEH, DEBORAH ZEMER, OSVALDORABINOVITCH, AND MORDECHAI PRAS Heller Institute ofMedical Research and Departments of Medicine and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel ABSTRACT: The effect of pregnancy on kidney function was studied in 29 pregnancies of 17 patients with familial Mediterranean fever (FMF) and amyloidosis. Pregnancy associated deterioration of renal function occurred in seven patients who had advanced renal disease at conception, marked by serum creatinine ~ 1.5 mg/dl or urine protein ~ 2 g/24 h. This finding suggests that the severity of renal disease at conception may predict the fate of kidney function during pregnancy and puerperium. (Am J Reprod Immunol. 1992; 28:243-244.) Key words: Amyloidosis, Familial Mediterranean Fever, kidney, pregnancy INTRODUCTION
Familial Mediterranean fever (FMF) is a genetic disease manifested by recurrent attacks of febrile serositis and the insidious development ofnephropathic AA amyloidosis.' Amyloidosis affects most untreated FMF patients. Its early stage is recognized by the appearance of proteinuria." Continuous colchicine treatment in a dose of 1-2 mg/day was found to prevent attacks in most patients and amyloidosis in all patients." However, amyloidosis is still encountered in uncompliant patients and in those who acquired amyloidosis prior to initiation of colchicine. The objective of this study is to elucidate the effect of pregnancy on renal function in FMF patients with amyloid nephropathy.
TABLE I. Factors That May Determine Kidney Function During Pregnancy or Puerperium Range
Factor studied Age at conception Creatinine at conception Proteinuria at conception Duration of proteinuria Creatinine at delivery
18-37 0.6-3 0.5-8 1-19 0.6-7
years mg/dl g/24h years mg/dl
Mean+SD 27 ± 4.5 years 8.2 ± 5 years
six intermediate. Figs. 1 and 2 show that the divergent outcome of kidney function in the 10 pregnancies with initial kidney disease of intermediate severity does not correlate with, and therefore may not be determined by the extent of daily proteinuria and the duration of overt amyloidosis at conception. Insufficient data on colchicine treatment and low frequency of hypertension (3/29 pregnancies) made their effect impossible to evaluate in the present study. Altogether these data suggest that in FMF amyloid nephropathy, renal function may be compromised in patients with more advanced renal disease at concep-
---...t=
8
N
7
00
1-0
-."
