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AL-amyloidosis is underdiagnosed in renal biopsies.
Nephrol Dial Transplant. 2004 Dec; 19(12):3050-3.ND

Abstract

BACKGROUND

Renal amyloidosis is associated with a variety of underlying disease processes. Although amyloid is identical in appearance in these diseases, the precursor proteins are different. Immunofluorescence microscopy has been used as the primary tool in the diagnostic evaluation of the underlying cause of renal AL-amyloidosis. The purpose of this study was to document the sensitivity of immunofluorescence microscopy in AL-amyloidosis.

METHODS

We reviewed 36 renal biopsies from patients with amyloidosis collected in two medical centres. All biopsies showed characteristic fibrillary deposits of amyloid on electron microscopy and stained positive with Congo red or Thioflavin-T.

RESULTS

Among these 36 patients, immunofluorescence staining for lambda and kappa light chains was negative or equivocal in 14 biopsies. Of these 14 patients, two patients had evidence of AA-amyloidosis. Twelve patients were found subsequently to have a plasma cell dyscrasia or multiple myeloma with monoclonal immunoglobulin and/or free light chains on immunofixation electrophoresis of urine or serum, and with evaluation of the bone marrow. Thus, 12 of 34 patients (35.3%) with proven AL-amyloidosis had negative immunofluorescence staining for kappa and lambda light chains.

CONCLUSIONS

The data demonstrated the low sensitivity of immunofluorescence microscopy in the detection of AL-amyloidosis in the kidney and underscore the need to pursue additional diagnostic studies to identify this problem.

Authors+Show Affiliations

Department of Pathology, University of Alabama at Birmingham, AL 35294, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

15507480

Citation

Novak, Lea, et al. "AL-amyloidosis Is Underdiagnosed in Renal Biopsies." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 19, no. 12, 2004, pp. 3050-3.
Novak L, Cook WJ, Herrera GA, et al. AL-amyloidosis is underdiagnosed in renal biopsies. Nephrol Dial Transplant. 2004;19(12):3050-3.
Novak, L., Cook, W. J., Herrera, G. A., & Sanders, P. W. (2004). AL-amyloidosis is underdiagnosed in renal biopsies. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 19(12), 3050-3.
Novak L, et al. AL-amyloidosis Is Underdiagnosed in Renal Biopsies. Nephrol Dial Transplant. 2004;19(12):3050-3. PubMed PMID: 15507480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - AL-amyloidosis is underdiagnosed in renal biopsies. AU - Novak,Lea, AU - Cook,William J, AU - Herrera,Guillermo A, AU - Sanders,Paul W, Y1 - 2004/10/26/ PY - 2004/10/28/pubmed PY - 2005/3/8/medline PY - 2004/10/28/entrez SP - 3050 EP - 3 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 19 IS - 12 N2 - BACKGROUND: Renal amyloidosis is associated with a variety of underlying disease processes. Although amyloid is identical in appearance in these diseases, the precursor proteins are different. Immunofluorescence microscopy has been used as the primary tool in the diagnostic evaluation of the underlying cause of renal AL-amyloidosis. The purpose of this study was to document the sensitivity of immunofluorescence microscopy in AL-amyloidosis. METHODS: We reviewed 36 renal biopsies from patients with amyloidosis collected in two medical centres. All biopsies showed characteristic fibrillary deposits of amyloid on electron microscopy and stained positive with Congo red or Thioflavin-T. RESULTS: Among these 36 patients, immunofluorescence staining for lambda and kappa light chains was negative or equivocal in 14 biopsies. Of these 14 patients, two patients had evidence of AA-amyloidosis. Twelve patients were found subsequently to have a plasma cell dyscrasia or multiple myeloma with monoclonal immunoglobulin and/or free light chains on immunofixation electrophoresis of urine or serum, and with evaluation of the bone marrow. Thus, 12 of 34 patients (35.3%) with proven AL-amyloidosis had negative immunofluorescence staining for kappa and lambda light chains. CONCLUSIONS: The data demonstrated the low sensitivity of immunofluorescence microscopy in the detection of AL-amyloidosis in the kidney and underscore the need to pursue additional diagnostic studies to identify this problem. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/15507480/AL_amyloidosis_is_underdiagnosed_in_renal_biopsies_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfh503 DB - PRIME DP - Unbound Medicine ER -