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August 1982

Primary Systemic Amyloidosis: Resolution of the Nephrotic Syndrome With Melphalan and Prednisone

Author Affiliations

From the Divisions of Hematology and Internal Medicine (Dr Kyle), and Nephrology and Internal Medicine (Dr Wagoner), and the Department of Anatomic Pathology (Dr Holley), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Arch Intern Med. 1982;142(8):1445-1447. doi:10.1001/archinte.1982.00340210037009

We describe two patients with primary systemic amyloidosis (AL) and the nephrotic syndrome. The administration of melphalan and prednisone was associated with resolution of the nephrotic syndrome. The serum albumin level returned to normal, proteinuria decreased to near normal, edema resolved, and the monoclonal protein in the serum and urine disappeared. In both patients, renal function remained stable and hepatomegaly disappeared. In both, however, amyloid deposition was greater in follow-up renal tissue than in the initial specimen. The effect of systemic therapy in AL must be assessed with histologic observations as well as clinical indexes.

(Arch Intern Med 1982;142:1445-1447)