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2014 ; 3
(2
): 217-222
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Chronic renal failure due to amyloid nephropathy caused by chronic infection
after total hip replacement
#MMPMID28509203
Nishimura S
; Matsumae T
; Murakami Y
; Abe Y
; Sasatomi Y
; Nagayoshi I
; Ueda K
; Nakashima H
CEN Case Rep
2014[Nov]; 3
(2
): 217-222
PMID28509203
show ga
A 75-year-old woman was admitted to our hospital because of proteinuria, pitting
edema on the foot, and renal impairment. She had undergone total hip replacement
(THR) for femoral neck fracture at the age of 66. Nine years later, she met with
an accident during farming and was treated at an emergency hospital for severe
general trauma. On the basis of systemic symptoms, she was diagnosed with
nephrotic syndrome. Renal biopsy by Congo-red staining and electron microscopy
revealed amyloid deposition on glomeruli, interstitium, and interlobar arteries.
The amyloid was immunohistochemically identified as AA amyloidosis. The patient
eventually required maintenance hemodialysis because of impaired renal function.
AA amyloidosis is an unusual complication of intractable inflammation. Chronic
infection with abscess occurred around the artificial hip joint following THR and
possibly induced secondary amyloidosis. THR is a common and necessary procedure
adopted for femoral neck fracture. Orthopedic surgeons should, however, carefully
monitor the occurrence of chronic infection after THR because such an infection
could lead to renal dysfunction and/or failure via AA amyloidosis in rare cases.