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. 2023 Sep 8;3(1):165-177.
doi: 10.1159/000533195. eCollection 2023 Jan-Dec.

Kidney Biopsy Corner: Amyloidosis

Laura E Biederman  1   2 , Alana D Dasgupta  1 , Darren E Dreyfus  3 , Tibor Nadasdy  1 , Anjali A Satoskar  1 , Sergey V Brodsky  1
Affiliations

Kidney Biopsy Corner: Amyloidosis

Laura E Biederman et al. Glomerular Dis. .

Abstract

Amyloidosis is an infiltrative disease caused by misfolded proteins depositing in tissues. Amyloid infiltrates the kidney in several patterns. There are, as currently described by the International Society of Amyloidosis, 14 types of amyloid that can involve the kidney, and these types may have different locations or clinical settings. Herein we report a case of AA amyloidosis occurring in a 24-year-old male with a history of intravenous drug abuse and provide a comprehensive review of different types of amyloids involving the kidney.

Keywords: AA amyloidosis; Amyloidosis; Intravenous drug use; Kidney biopsy; Mass spectrometry.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Amyloid A amyloidosis (AA). a H&E stain showing diffuse infiltration of the glomeruli by amorphous material (×10). b PAS stain showing the material is weakly PAS-positive material (×20). c Silver stain: the material is silver negative. d Classic “spikes” or “spicules” (arrows) seen on the subepithelial aspect of the basement membranes on silver stain (×60).
Fig. 2.
Fig. 2.
Amyloid A amyloidosis (AA). a Positive Congo red special stain (×40). b Apple green birefringence on polarization (×40). c Amyloid A immunohistochemical stain showing diffuse staining in the glomeruli, vessels, and mesangium (×10).
Fig. 3.
Fig. 3.
Amyloid A amyloidosis (AA). a Electron microscopy showing fibrils expanding and replacing the mesangium. b Fibrils extending along the glomerular capillary loop basement membranes. c Non-branching, randomly arranged fibrils with an average diameter of 10.43 nm.
Fig. 4.
Fig. 4.
Light chain amyloidosis (AL). a Amyloid involving the glomeruli, interstitium, and vessels (PAS stain; ×20). b Spikes (arrows) in the basement membrane (silver stain; ×60). c Congo red stain highlighting amyloid in the glomeruli (×20). d Lambda light chain immunofluorescence highlighting bright staining amyloid material in the glomeruli, interstitium, and vessels (×10).
Fig. 5.
Fig. 5.
Fibrinogen A α amyloidosis (AFib). a Amorphous amyloid material completely replacing the glomeruli (H&E, ×10). b Congo red stain highlighting the amyloid with a strikingly glomerular distribution (×10). c Silver-negative amyloid material with no spike formation in the glomeruli (×40). d Bright staining for fibrinogen on immunofluorescence (Fibrinogen immunofluorescence, ×20).
Fig. 6.
Fig. 6.
Gelosin amyloidosis (AGel). a Congo red-positive amyloid involving the glomeruli and vessels (×10). b Congo red-positive amyloid involving the glomeruli and an arteriole (×40). c Silver-negative amyloid without distinct spike formation (silver stain, ×40).
Fig. 7.
Fig. 7.
LECT2 amyloidosis (ALECT2). a PAS-pale material predominantly in the interstitium (PAS stain, ×10). b Congo red-positive material predominantly involving the mesangium with minimal glomerular involvement (×10). c Silver-pale amyloid material in vessels (silver stain, ×40).
Fig. 8.
Fig. 8.
Transthyretin amyloidosis (ATTR). a Amorphous amyloid material involving vessels only (H&E, ×20). b Congo red-positive material in vessel walls (×20). c Congo red amyloid in vessel walls with glomerular sparing (×20).
Fig. 9.
Fig. 9.
Apolipoprotein AIV amyloidosis (AApoAIV). a Amyloid material in the deep medulla interstitium and tubular basement membranes (H&E, ×10). b Congo red highlighting amyloid along the tubular basement membranes and interstitium (×10). c Cortex with no evidence of amyloid deposition (Congo red, ×20).
Fig. 10.
Fig. 10.
Apolipoprotein CII amyloidosis (AApoCII). a Amorphous amyloid material involving the glomeruli (H&E, ×10). b Amyloid material involving a glomerulus; Congo red stain was negative (H&E, ×40). c Silver-negative amyloid material in the mesangium.
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References

    1. Hawkins PN. Amyloidosis. Blood Rev. 1988;2(4):270–80. 10.1016/0268-960x(88)90016-1. - DOI - PubMed
    1. Linke RP. Highly sensitive diagnosis of amyloid and various amyloid syndromes using Congo red fluorescence. Virchows Arch. 2000;436(5):439–48. 10.1007/s004280050471. - DOI - PubMed
    1. Giannini G, Nast CC. An organ system-based approach to differential diagnosis of amyloid type in surgical pathology. Arch Pathol Lab Med. 2020;144(3):379–87. 10.5858/arpa.2018-0509-RA. - DOI - PubMed
    1. Linke RP. On typing amyloidosis using immunohistochemistry. Detailled illustrations, review and a note on mass spectrometry. Prog Histochem Cytochem. 2012;47(2):61–132. 10.1016/j.proghi.2012.03.001. - DOI - PubMed
    1. Sethi S, Dasari S, Plaisier E, Ronco P, Nasr SH, Brocheriou I, et al. Apolipoprotein CII amyloidosis associated with p.Lys41Thr mutation. Kidney Int Rep. 2018;3(5):1193–201. 10.1016/J.EKIR.2018.04.009. - DOI - PMC - PubMed