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A Case of Renal Amyloidosis

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Stanley Medical College, Department of Medicine
Santé & Médecine
1  sur  42
A Case of Anasarca for Evaluation PROF P.VIJAYARHAGAVAN’ S UNIT C. R. RAJ KUMAR
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TOTAL COUNT 8500cells/cumm DC POLYMORPHS 68% LYMPHOCYTES 36% EOSINOPHILS 6% PCV 34.7 MCV 90.8fl MCH 29.3pg MCHC 32.3g HB 11.2gm ESR 38mm/ hr PROTHROMBIN TIME TEST -14 APTT 26 PLATELETS 79000 RBC 3.8 million
RFT SUGAR 90mg UREA 18mg CREATININE 0.7mg LFT TOTAL BILIRUBIN 0.42mg DIRECT 0.28mg AST 33u ALT 17 ALK PHOSPATASE 159 GGT 23 TOTAL PROTEIN 4mg ALBUMIN 1.2mg GLOBULINS 2.8mg
ELECTROLYTES SODIUM 131.3meq POTTOSIUM 4.33meq CHLORIDE 94.3meq SEROLOGY HIV NEGATIVE ANTIHCV NEGATIVE HbsAg POSITIVE URINE SUGAR NIL ALBUMIN + DEPOSITS 4-6 pus cells, no RBC,no casts
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SERUM IMMUNO ELECTROPHORESIS
 
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RENAL BIOPSY
 
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MONOCLONAL GAMMOPATHY ,[object Object],[object Object],[object Object]
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*see below Disease M-protein type Associated clinical features Monoclonal Gammopathy of Uncertain Significance (MGUS) Any in small quantity None Multiple Myeloma IgG, IgA, light chain only, IgD CRAB* Lymphoplasmacytoid-Cell Lymphoma (Waldenström's Macroglobulinemia) IgM OVA* amyloidosis Any of the above Protein deposition in multiple organ systems
[object Object],[object Object],[object Object],Underlying disorder Effects MGUS, MM, WM Light chains metabolized to form amyloid which accumulates in organs Organ infiltrated Effects Heart Diastolic dysfunction - CHF Liver/spleen Enlargement Kidney Nephrotic syndrome, renal failure Nerves Neuropathy Skin Bleeding, bruising Gut Large tongue. Dysmotility Treatment Chemotherapy Prognosi Poor: average survival about 1 year ( Kyle 1997 ) Treatment Chemotherapy Prognosis Poor: average survival about 1 year ( Kyle 1997 )
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A Case of Renal Amyloidosis

  • 1. A Case of Anasarca for Evaluation PROF P.VIJAYARHAGAVAN’ S UNIT C. R. RAJ KUMAR
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  • 14. TOTAL COUNT 8500cells/cumm DC POLYMORPHS 68% LYMPHOCYTES 36% EOSINOPHILS 6% PCV 34.7 MCV 90.8fl MCH 29.3pg MCHC 32.3g HB 11.2gm ESR 38mm/ hr PROTHROMBIN TIME TEST -14 APTT 26 PLATELETS 79000 RBC 3.8 million
  • 15. RFT SUGAR 90mg UREA 18mg CREATININE 0.7mg LFT TOTAL BILIRUBIN 0.42mg DIRECT 0.28mg AST 33u ALT 17 ALK PHOSPATASE 159 GGT 23 TOTAL PROTEIN 4mg ALBUMIN 1.2mg GLOBULINS 2.8mg
  • 16. ELECTROLYTES SODIUM 131.3meq POTTOSIUM 4.33meq CHLORIDE 94.3meq SEROLOGY HIV NEGATIVE ANTIHCV NEGATIVE HbsAg POSITIVE URINE SUGAR NIL ALBUMIN + DEPOSITS 4-6 pus cells, no RBC,no casts
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  • 24. SERUM IMMUNO ELECTROPHORESIS
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  • 40. *see below Disease M-protein type Associated clinical features Monoclonal Gammopathy of Uncertain Significance (MGUS) Any in small quantity None Multiple Myeloma IgG, IgA, light chain only, IgD CRAB* Lymphoplasmacytoid-Cell Lymphoma (Waldenström's Macroglobulinemia) IgM OVA* amyloidosis Any of the above Protein deposition in multiple organ systems
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