Treatment with chlorambucil of renal amyloidosis secondary to rheumatoid arthritis. Study of 6 cases

BACKGROUND: Amyloidosis is a common complication of rheumatoid arthritis, R enal disease is the main manifestation and its usual outcome is the lost of renal function. Some clinical evidences suggest that low-dose treatment wi th chlorambucil may be effective as therapy of this complication. PATIENTS AND METHODS: The effect of chlorambucil treatment in a group of si x patients diagnosed by renal biopsy of renal amyloidosis secondary to rheu matoid arthritis was evaluated. Patients were treated with 0.1 mg/kg body w eight/day for a time above a year until reduction of proteinuria. RESULTS: 3 out Of 6 patients showed decrease of proteinuria below 500 mg/da y, two patients have started renal replacement therapy and one died without response to treatment. It was detected non reversible azoospermia In one p atient. Mean follow-up time has been sixty months. CONCLUSIONS: Chlorambucil may be effective in the treatment of renal amyloi dosis secondary to rheumatoid arthritis when treatment starts before renal function is Impaired. Long term remissions can be obtained even after suspe nding treatment.