COMBINED TREATMENT WITH CYCLOPHOSPHAMIDE AND PREDNISOLONE CAN INDUCE REMISSION OF NEPHROTIC SYNDROME IN A PATIENT WITH RENAL AMYLOIDOSIS, ASSOCIATED WITH RHEUMATOID-ARTHRITIS

A 67-year-old woman, who had been diagnosed with classical rheumatoid arthritis (RA), was admitted to our hospital because of massive protei nuria. Biopsy of the kidney revealed deposition of amyloid fibrils in the subepithelial and subendothelial spaces of the glomerular capillar y walls. Though the treatment with prednisolone and dipyridamole again st nephrotic syndrome and amyloidosis due to RA was not effective, cyc lophosphamide, which was added after tapering of prednisolone, was abl e to induce remission of nephrotic syndrome after two years. The level s of CRP and serum amyloid A protein (SAA) returned to within the norm al limits. As the impairment of renal function is thought to be due to deposition of amyloid supplied from the precursors of amyloid fibrils filtered from the general circulation in RA patients, remission of ne phrotic syndrome might result from the suppression of production of SA A or removal of amyloid fibrils. Cyclophosphamide, which has the poten tial both to suppress disease activity in RA. and to produce degradati on of amyloid fibrils in glomeruli, may be useful against renal or sys temic amyloidosis complicated by RA.