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NDT Advance Access originally published online on October 26, 2004
Nephrology Dialysis Transplantation 2004 19(12):3050-3053; doi:10.1093/ndt/gfh503
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Nephrol Dial Transplant Vol. 19 No. 12 © ERA-EDTA 2004; all rights reserved

Original Article

AL-amyloidosis is underdiagnosed in renal biopsies

Lea Novak1, William J. Cook1, Guillermo A. Herrera4,5,6 and Paul W. Sanders2,3,7

Departments of 1 Pathology, 2 Medicine, and 3 Physiology and Biophysics, University of Alabama at Birmingham, AL, Departments of 4 Pathology, 5 Medicine, and 6 Cellular Biology and Anatomy, LSU Health Sciences Center, Shreveport, LA and 7 Veterans Affairs Medical Center, Birmingham, AL, USA

Correspondence and offprint requests to: Paul W. Sanders, MD, Division of Nephrology, LHRB 642, University of Alabama at Birmingham, 1530 Third Avenue, South Birmingham, AL 35294-0007, USA. Email: psanders{at}uab.edu

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.

Keywords: amyloidosis; kidney biopsy; multiple myeloma; plasma cell dyscrasia; renal biopsy


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