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Vol. 34. Issue 1.
Pages 111-115 (January 2010)
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Vol. 34. Issue 1.
Pages 111-115 (January 2010)
Secondary amyloidosis of the bladder and massive hematuria
Amiloidosis vesical secundaria y hematuria masiva
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A. García-Escudero Lópeza,
Corresponding author
agareslo@telefonica.net

Author for correspondence.
, A. Arruza Echevarríaa, J. Leunda Saizara, R. Infante Riañoa, J. Padilla Nievaa, E. Ortiz Barredob
a Servicio de Urología, Hospital Txagorritxu, Vitoria, Álava, Spain
b Servicio de Anatomía Patológica, Hospital Txagorritxu, Vitoria, Álava, Spain
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Abstract
Objective

To report four additional cases of secondary amyloidosis of the bladder, an extremely rare condition, as shown by the cases reported in the literature.

Materials and methods

Four clinical cases are reported, all of them occurring as hematuria, which was massive and fulminant and resulted in death in three patients.

Results

Secondary amyloidosis of the bladder is of the AA type, which is more common in females and mainly secondary to rheumatoid arthritis, but also to ankylosing spondylitis and long-standing chronic inflammatory conditions. Hematuria is the main and virtually only symptom. A pathological and immunohistochemical study confirmed diagnosis. All three patients who experienced massiva, fatal hematuria had an intercurrent condition requiring urethral catheterization, which was the triggering factor.

Conclusions

Despite its rarity, as shown by the few cases reported, secondary amyloidosis of the bladder should be considered in patients already diagnosed with systemic amylodosis and/or the conditions reported who require simple urethral catheterization.

Keywords:
Secondary amyloidosis
Urinary bladder
Massive hematuria
Resumen
Objetivo

: Dar a conocer cuatro nuevos casos de amiloidosis vesical secundaria, cuya manifestación clínica es extraordinariamente rara, si atendemos a los escasos casos publicados que no llegan a la treintena.

Material y métodos

Describimos los cuatro casos clínicos, manifestados todos ellos por hematuria, siendo en tres masiva y fulminante, con evolución fatal.

Resultados

La amiloidosis vesical secundaria corresponde al tipo AA, más frecuente en mujeres y secundaria sobre todo a artritis reumatoide, pero también a espondilitis anquilopoyética y procesos inflamatorios crónicos de larga evolución. La hematuria es el síntoma fundamental, prácticamente único. El estudio patológico e inmunohistoquímico confirma el diagnóstico. Se da la circunstancia de que los tres casos de hematuria masiva y fatal presentaron una patología intercurrente que precisó practicar un sondaje uretral, siendo éste el desencadenante.

Conclusiones

A pesar de su rareza, confirmada por los pocos casos publicados, habrá que pensar en ella ante pacientes ya diagnosticados de amiloidosis sistémica y/o con las patologías descritas, que precisen un simple sondaje uretral.

Palabras clave:
Amiloidosis secundaria
Vejiga urinaria
Hematuria masiva

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