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:
**Core Concept**
The question is testing the student's knowledge of amyloidosis, a condition characterized by the deposition of amyloid fibrils in various tissues, including the kidneys. Amyloidosis can be caused by a variety of factors, including chronic diseases, genetic mutations, and plasma cell dyscrasias.
**Why the Correct Answer is Right**
The presence of pink amorphous material in the renal biopsy, which shows apple-green birefringence under polarized light after Congo red staining, is indicative of amyloid deposition. The deposits are positive for lambda light chains, suggesting that they are of monoclonal origin. This is a hallmark of primary amyloidosis (AL amyloidosis), which is associated with plasma cell dyscrasias such as multiple myeloma. The deposition of amyloid fibrils in the kidneys can lead to renal failure, as seen in this patient. The lambda light chain positivity suggests that the amyloid deposits are composed of immunoglobulin light chains, which are produced by a clone of plasma cells.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the scenario described. The presence of amyloid deposits in the kidneys, positive for lambda light chains, is not consistent with a diagnosis of diabetic nephropathy.
**Option B:** This option is also not relevant to the scenario described. The presence of amyloid deposits in the kidneys, positive for lambda light chains, is not consistent with a diagnosis of hypertensive nephrosclerosis.
**Option C:** This option is not relevant to the scenario described. The presence of amyloid deposits in the kidneys, positive for lambda light chains, is not consistent with a diagnosis of focal segmental glomerulosclerosis (FSGS).
**Option D:** This option is not relevant to the scenario described. The presence of amyloid deposits in the kidneys, positive for lambda light chains, is not consistent with a diagnosis of membranous nephropathy.
**Clinical Pearl / High-Yield Fact**
Amyloidosis is a systemic disease that can affect multiple organs, including the kidneys, heart, liver, and nervous system. The diagnosis of amyloidosis often requires a combination of clinical evaluation, laboratory tests, and biopsy. The presence of amyloid deposits in the kidneys is a hallmark of the disease, and the identification of lambda light chains in the deposits can help to guide treatment.
**Correct Answer: D. Primary amyloidosis (AL amyloidosis)**