Comparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome

Abstract

BackgroundAmyloidosis leads to deposition of abnormal protein with beta-pleated sheet structure in specific compartments of the affected organs. The histological localization of these amyloid deposits determines the overall survival of the patient.MethodsIn this study we have assessed the histological localization and severity of amyloid deposition in 35 patients with biopsy-proven renal amyloidosis and have compared those to clinical parameters, histo-pathological injury criteria and respective patient outcome. Comparisons were statistically analyzed using thus comparison between the different study groups, which was done using Student t-test and analysis of variance.ResultsWe find that the glomerulus is by far the most commonly and most severely affected renal compartment and patients with severe glomerular amyloidosis advance faster towards end stage renal disease (ESRD) and death, compared to those patients without glomerular amyloid deposits. Patients with severe glomerular amyloidosis showed higher serum creatinine and urine protein levels, while patients with severe vascular amyloidosis showed higher levels of interstitial inflammatory infiltrate.ConclusionIn kidneys affected by amyloidosis, the amyloid proteins are predominantly deposited along vessels, especially the small vessels including glomerular capillary loops. The severity of glomerular amyloid deposition enhances the risk of developing ESRD and increases the risk for premature death.

A Novel Method of DAPI Staining for Differential Diagnosis of Renal Amyloidosis

“…These results suggest that DAPI-staining can be a useful way to discriminate AL and AA amyloidoses. It is also well known that glomerular amyloid deposition is categolized into several types : 1) a mesangiocapillary type with diffuse amyloid deposition in the mesangium and along both sides of the glomerular basement membrane ; 2) a perimembranous type principally involving the subepithelial side of the basement membrane ; 3) a mesangial nodular type showing nodular mesangial deposits ; 4) and a hilar type showing amyloid deposits in hilar arterioles (9)(10)(11). We demonstrated here that DAPI-PI double staining clarifies the difference in amyloid deposition types more effectively.…”

An Organ System–Based Approach to Differential Diagnosis of Amyloid Type in Surgical Pathology

“…1 Prognosis also may depend on amyloid load and density, which should be included with amyloid reporting. 6,7 Amyloid proteins have varying propensities for organ system involvement, and the pattern of organ deposition may suggest the amyloidogenic protein involved. 8,9 Therefore, knowing the amyloid types most often found in specific organ systems allows the pathologist to provide a more specific differential diagnosis, potentially guiding the patient's clinical evaluation.…”

Leukocyte Cell-Derived Chemotaxin-2 Amyloidosis (ALECT2) in a Patient With Lung Adenocarcinoma: An Autopsy Report and Literature Review

“…Glomeruli and medulla were uninvolved ( Figure 1). These aspects differentiate ALECT2 from other forms of amyloidosis with distinctive morphologic patterns, such as AA and AL, which primarily involve the glomerulus 14 ; apolipoprotein A-IV amyloidosis, which has predominantly medullary involvement 15 ; and fibrinogen α-chain amyloidosis, which typically shows florid deposition restricted to the glomeruli. 16 ALECT2 is probably an underdiagnosed cause of endstage renal disease because bland urinary sediment, proteinuria, and slowly declining renal function are not typical indications for a renal biopsy.…”