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Dr. Saiki replies To the Editor: We thank Prof. Pruzanski for his kind comments on our report about renal amyloidosis in patients with RA. As written in our abstract, we followed 38 patients with renal amyloidosis, and in 27 patients amyloid deposition was found exclusively in the glomerulus (type 1) and in 11 in the blood vessels only (type 2). However, in the Results we stated that among 27 patients the amyloid was "exclusively" found in the glomeruli in 7 cases only, as suggested by the comment. The word "exclusively" was inadequate and we should have used "selectively" in its place. That is why the statement is not contradicting the abstract. Of 27 patients with type 1 who had amyloid in the glomerulus, 20 had amyloid deposition in the blood vessels simultaneously, but the other 7 had no amyloid deposition in the blood vessels. Therefore, in Figure 3, the survival curves apply to 27 patients with glomerular involvement (type 1) and 11 without glomerular involvement (type 2). We also agree that it would be of interest to know if some control patients with RA and negative duodenal biopsy have renal amyloidosis. In our center, however, it was not easy to carry out renal biopsy in all patients with RA who had no renal involvement. We are sorry for not stating the number of glomeruli in the biopsy. We examined more than 10 glomeruli for the diagnosis of type 1, but more than 20 glomeruli were examined for type 2. In the text, we show few glomeruli because of space limitations. In some cases we stained renal biopsies for kappa, lambda, and immunoglobulin chains, but we found no case of mixed AL and AA amyloidosis. We also examined renal biopsy at the end of the followup study, especially in the patients with type 2 disease. We are now preparing a manuscript describing these results. OSAMU SAIKI, MD, Professor of Rehabilitation, Osaka Prefecture University, Habikino 3-7-30, Osaka 583-8555, Japan. E-mail: osaiki@rehab.osakafu-u.ac.jp |