A renal biopsy from a 56 year old woman with progressive renal failure for the past 3 years shows glomerular and vascular deposition of pink amorphous material. It shows apple-green birefringence under polarized light after Congo red staining. These deposits are positive for lambda light chains. The person is most likely to suffer from:
Correct Answer: Multiple myeloma
Description: Ans. is 'd' i.e. Multiple myeloma Pink and amorphous material that shows apple green birefringence under polarized light confirms the diagnosis of Amyloidosis.Now we have to look for a disease which can be complicated by amyloidosis (from the given options). Out of the given four, three diseases can be complicated by Amyloidosis. These areRheumatoid arthritisTuberculosis andMultiple myelomaBut there is one more clue i.e. the presence of Lambda light chains.This easily leads us to the diagnosis, as lambda light chains are present in AL type of amyloid protein.AL type of amyloid is seen in multiple myeloma.Rheumatoid arthritis and T.B. are associated with AA type of amyloid protein.More about Amyloidosis:* Chemical nature of AmyloidChemically amyloid is a protein.15 biochemical forms of proteins have been identified Two most common forms areAL protein (amyloid light chain)It is derived from plasma cells (immunocyte)It contains immunoglobulin light chainsIt is associated with primary amyloidosis e.g. Multiple myelomaAA protein (amyloid associated protein)It is a non proteinIt is synthesized by liverIt is seen in secondary amyloidosisClassification of AmyloidosisSystemic AmyloidosisLocalized amyloidosisPrimary amyloidosis |Associated with AL proteinSeen inMultiple myelomaand other monoclonal B cell proliferationSecondary amyloidosis |associated with AA proteinSeen inChronic inflammatory conditions such asT.B.Rheumatoid arthritisLeprosySyphilisChronic bronchitisSenile cerebral amyloidosisEndocrine -Medullary ca of thyroid * Islet of LangerhansIsolated, atrial amyloidosis
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