Renal amyloidosis: Origin and clinicopathologic correlations of 474 recent cases

Samar M. Said, Sanjeev Sethi, Anthony M. Valeri, Nelson Leung, Lynn D. Cornell, Mary E. Fidler, Loren Herrera Hernandez, Julie A. Vrana, Jason D. Theis, Patrick S. Quint, Ahmet Dogan, Samih H. Nasr

Research output: Contribution to journalArticle

112 Scopus citations

Abstract

Background and objectives The kidney is the organ most commonly involved in systemic amyloidosis. This study reports the largest clinicopathologic series of renal amyloidosis. Design, setting, participants, & measurements This study provides characteristics of 474 renal amyloidosis cases evaluated at the Mayo Clinic Renal Pathology Laboratory from 2007 to 2011, including age, sex, serum creatinine, proteinuria, type of amyloid, and tissue distribution according to type. Results The type of amyloid was Ig amyloidosis in 407 patients (85.9%), AA amyloidosis in 33 (7.0%), leukocyte chemotactic factor 2 amyloidosis in 13 (2.7%), fibrinogen A a chain amyloidosis in 6 (1.3%), Apo AI, Apo AII, or Apo AIV amyloidosis in 3 (0.6%), combined AA amyloidosis/Ig heavy and light chain amyloidosis in 1 (0.2%), and unclassified in 11 (2.3%). Laser microdissection/mass spectrometry, performed in 147 cases, was needed to determine the origin of amyloid in 74 of the 474 cases (16%), whereas immunofluorescence failed to diagnose 28 of 384 light chain amyloidosis cases (7.3%). Leukocyte chemotactic factor 2 amyloidosis and Apo AI, Apo AII, or Apo AIV amyloidosis were characterized by diffuse interstitial deposition, whereas fibrinogen A a chain amyloidosis showed obliterative glomerular involvement. Compared with other types, Ig amyloidosis was associated with lower serum creatinine, higher degree of proteinuria, and amyloid spicules. Conclusions In the authors' experience, the vast majority of renal amyloidosis cases are Ig derived. The newly identified leukocyte chemotactic factor 2 amyloidosis form was the most common of the rarer causes of renal amyloidosis. With the advent of laser microdissection/mass spectrometry for amyloid typing, the origin of renal amyloidosis can be determined in >97% of cases.

Original languageEnglish (US)
Pages (from-to)1515-1523
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number9
DOIs
StatePublished - 2013

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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    Said, S. M., Sethi, S., Valeri, A. M., Leung, N., Cornell, L. D., Fidler, M. E., Hernandez, L. H., Vrana, J. A., Theis, J. D., Quint, P. S., Dogan, A., & Nasr, S. H. (2013). Renal amyloidosis: Origin and clinicopathologic correlations of 474 recent cases. Clinical Journal of the American Society of Nephrology, 8(9), 1515-1523. https://doi.org/10.2215/CJN.10491012