Final Diagnosis -- Advanced Amyloidosis of Kidney

FINAL DIAGNOSIS:

KIDNEY, RIGHT, PERCUTANEOUS RENAL BIOPSY:

• ADVANCED AMYLOIDOSIS (AMYLOID A) OF KIDNEY, WITH INVOLVEMENT OF GLOMERULI AND INTRARENAL BLOOD VESSELS (h/o chronic rheumatoid arthritis).
• CHRONIC SECONDARY ISCHEMIA WITH MARKED CHRONICITY CHANGES INVOLVING GLOMERULI (global glomerulosclerosis (37%)), TUBULES, INTERSTITIUM AND VASCULATURE OF KIDNEY.

Contributor's Note:

In summary, this patient has advanced chronic renal disease secondary to deposition of amyloid A within the kidney. Amyloid A is a recognized complication of chronic inflammatory disorders including rheumatoid arthritis. Extra-renal amyloid involvement should be assessed. In spite of the clinical history of rheumatoid vasculitis, there is no evidence of an active vasculitis or glomerulonephritis in the kidney biopsy; prior (healed) renal necrotizing vasculitis/glomerulonephritis cannot be excluded.

REFERENCES

Contributed by Jianzhou Wang, MD., PhD., Sheldon Bastacky, MD