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CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(02): 226-231
DOI: 10.4103/JLP.JLP_148_17
Original Article

Revisiting renal amyloidosis with clinicopathological characteristics, grading, and scoring: A single-institutional experience

Abhiram Kalle
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Archana Gudipati
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sree Bhushan Raju
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Karthik Kalidindi
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Swarnalatha Guditi
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Gangadhar Taduri
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Megha S. Uppin
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
› Author Affiliations Financial support and sponsorship Nil
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Abstract

INTRODUCTION: Kidney involvement is a major cause of mortality in systemic amyloidosis. Glomerulus is the most common site of deposition in renal amyloidosis, and nephrotic syndrome is the most common presentation. Distinction between AA and AL is done using immunofluorescence (IF) and immunohistochemistry (IHC). Renal biopsy helps in diagnosis and also predicting the clinical course by applying scoring and grading to the biopsy findings.

MATERIALS AND METHODS: The study includes all cases of biopsy-proven renal amyloidosis from January 2008 to May 2017. Light microscopic analysis; Congo red with polarization; IF; IHC for Amyloid A, kappa, and lambda; and bone marrow evaluation were done. Classification of glomerular amyloid deposition and scoring and grading are done as per the guidelines of Sen S et al.

RESULTS: There are 40 cases of biopsy-proven renal amyloidosis with 12 primary and 23 secondary cases. Mean age at presentation was 42.5 years. Edema was the most common presenting feature. Secondary amyloidosis cases were predominant. Tuberculosis was the most common secondary cause. Multiple myeloma was detected in four primary cases. Grading of renal biopsy features showed a good correlation with the class of glomerular involvement.

CONCLUSION: Clinical history, IF, and IHC are essential in amyloid typing. Grading helps provide a subtle guide regarding the severity of disease in the background of a wide range of morphological features and biochemical values. Typing of amyloid is also essential for choosing the appropriate treatment.

Keywords

Grading - mmunofluorescence - immunohistochemistry - renal amyloidosis - typing of amyloid


Publication History

Received: 24 September 2017

Accepted: 16 January 2018

Article published online:
19 February 2020

© 2018.

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