Case
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Diagnosis: AL amyloidosis
Light-chain (AL) amyloidosis is the most common form of systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. In our patient, a monoclonal spike was detected in serum, and a plasm cell proliferation was diagnosed in bone marrow biopsy.
In our case was very interesting that glomerular amyloid was positive with the silver staining, including "spikes" in capillary walls (Figures 6 and 7). In previous works, these "spikes" demonstrated to be amyloid by electron microscopy (Link to see an image). Although amyloid is usually negative with the silver stain, I have seen cases with positive methenamine-silver staining. I do not know why, but the amyloid molecules are so diverse in their biochemical composition, that it is quite possible that some types show such staining.
Visit the chapter Amyloidosis, Multiple Mieloma... of our Tutorial.
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References
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Kuroda T, Tanabe N, Kobayashi D, Wada Y, Murakami S, Nakano M, Narita I. Significant association between renal function and amyloid-positive area in renal biopsy specimens in AL amyloidosis. BMC Nephrol. 2012;13:118. [PubMed link] [Full text link]
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Suzuki K. Diagnosis and treatment of multiple myeloma and AL amyloidosis with focus on improvement of renal lesion. Clin Exp Nephrol. 2012;16(5):659-71. [PubMed link] [Full text link]
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Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, Quellard N, Lacombe C, Goujon JM, Lavergne D, Abraham J, Touchard G, Fermand JP, Jaccard A. Al amyloidosis. Orphanet J Rare Dis. 2012 Aug 21;7:54. [PubMed link] [Full text link]
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Itabashi M, Takei T, Tsukada M, Sugiura H, Uchida K, Tsuchiya K, Honda K, Nitta K. Association between clinical characteristics and AL amyloid deposition in the kidney. Heart Vessels. 2010;25(6):543-8. [PubMed link]
- Sanchorawala V. Light-chain (AL) amyloidosis: diagnosis and treatment. Clin J Am Soc Nephrol. 2006;1(6):1331-41. [PubMed link] [Full text link]