Table 3.

Key points—diagnostic pathway for amyloidosis.

  1. Consider AL in differential if:

    • Nondiabetic nephrotic syndrome

    • Cardiomyopathy nonischemic: echo shows “left ventricular hypertrophy (LVH)”

    • Hepatomegaly with no scan defects

    • Chronic inflammatory demyelinating polyneuropathy

    • “Atypical myeloma” urine light chain + and marrow < 10% plasma cells

  2. Perform immunofixation serum, urine, and immunoglobulin free light chain assay. If positive, amyloidosis becomes a likely explanation.

  3. Biopsy bone marrow and subcutaneous fat. Do Congo red stains. Biopsy of kidney or liver are usually not required.

  4. Assess prognosis. Echocardiography with Doppler. Serum troponin, brain nateiuretic peptide (BNP), β2-microglobuin.

  5. Initiate therapy.

 

  1. Consider AL in differential if:

    • Nondiabetic nephrotic syndrome

    • Cardiomyopathy nonischemic: echo shows “left ventricular hypertrophy (LVH)”

    • Hepatomegaly with no scan defects

    • Chronic inflammatory demyelinating polyneuropathy

    • “Atypical myeloma” urine light chain + and marrow < 10% plasma cells

  2. Perform immunofixation serum, urine, and immunoglobulin free light chain assay. If positive, amyloidosis becomes a likely explanation.

  3. Biopsy bone marrow and subcutaneous fat. Do Congo red stains. Biopsy of kidney or liver are usually not required.

  4. Assess prognosis. Echocardiography with Doppler. Serum troponin, brain nateiuretic peptide (BNP), β2-microglobuin.

  5. Initiate therapy.

 
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