Methods of diagnosis of amyloidosis
Diagnosis is difficult and primary amyloidosisIt requires the use of all possible methods. Secondary amyloidosis authorities recognized a little easier, because we know the disease that can lead to its development.
Specific changes in laboratoryamyloidosis not. However, for patients characterized by significantly elevated erythrocyte sedimentation rate (50-70 mm / h) and anemia (in some cases marked thrombocytosis - reduction of platelet count, increased fibrinogen levels in the blood). Apply special tests for amyloid (with kongorot, methylene blue, which normally change the color of urine, whereas the patients they are fixed amyloid and excreted in the urine in minimum quantities), and electrophoretic urine proteins.
When amyloidosis of the heart is recorded on an electrocardiogramlow voltage peaks. During the ultrasound study of the heart (echocardiography) says a combination of increased echogenicity (permeability) and myocardial thickening of the walls of the atria that in 60-90% of cases indicates amyloidosis.
In proteinuric stage renal amyloidosisrevealed a small amount of protein in the urine and the periodic appearance of red blood cells, which sometimes is found only in the urine sediment study by the method of Aleksander Kakowski-Addis. Furthermore, in the urine are determined individual cylinders (hyaline, granular, waxy) and leukocytes. In some cases, significantly reduced renal blood flow and filtration.
In nephrotic stage increases the amount ofalbumin (plasma low molecular weight proteins), including urine protein predominate globulins, especially their large particles. There gammaglikoproteidov high content of alpha-lipoproteins in the urine. The urine sediment detected a small amount of red blood cells, white blood cells and often the cylinder.
There is a decrease in blood protein levelviolation of their ratio (albuminoglobulinovy coefficient decreases to 1.0 or lower), predominate among globulins and alpha 2 gamma fraction. There may be an increased level of blood cholesterol. Sometimes blood revealed a moderate increase in creatinine, urea and residual nitrogen - uric acid metabolites. There may be slight changes in the fundus. Of great importance in the diagnosis of renal biopsy belongs. In addition, to help clarify the diagnosis of X-ray and radioindikatsionnyh methods.
When amyloidosis liver laboratory studyidentifies specific protein changes, especially alpha-2-globulinemiyu, immune disorders, often increased serum alkaline phosphatase activity and other functional tests changed little. The greatest diagnostic value has a needle biopsy of the liver.
Treatment of primary amyloidosis is associated withgreat difficulties. For success in the treatment of secondary amyloidosis can be expected only if the organs are no gross changes as well, if you eliminate the reasons advanced development. Treatment includes diet, gentle treatment, if possible - the radical elimination of the underlying disease (osteomyelitis, tumor), the appointment of pathogenetic and symptomatic agents.
To include the appointment of pathogenetic therapyhingamina to 0.25 g per day, 5% unitiola 5-10 ml intramuscular injection of 20-30 courses, colchicine (effective in hereditary forms), 2 mg per day, immunosuppressant with amyloidosis, caused myeloma and primary forms of the disease.
Symptomatic means used byindications (antihypertensives, diuretics, desensitizing agents, iron supplements, vitamins, cardiac glycosides, transfusion of whole blood and blood components, and so gepatoprotektory. d.). With the development of chronic renal failure should be resolved the issue of hemodialysis and kidney transplantation.