Renal amyloidosis: Case series report and literature review
Main Article Content
Abstract
Amyloidosis is a group of rare, severe disorders characterized by the deposition of amyloid protein in tissues such as the kidney, brain, and heart. We reported three cases of amyloid nephropathy diagnosed and treated at Bach Mai Hospital between January 2024 and March 2025. Diagnosis was established through renal biopsy, demonstrating amyloid deposition with characteristic Congo red birefringence. The poor renal response in all three cases suggests that amyloid nephropathy remains a diagnostic and therapeutic challenge. This report emphasizes the importance of screening for amyloid as a secondary cause of nephrotic syndrome in the elderly, and the importance of renal biopsy in the diagnosis and treatment of nephrotic syndrome in this patient group.
Article Details
Keywords
Amyloidosis, nephrotic syndrome, cases report
References
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2. Merlini G. AL amyloidosis: from molecular mechanisms to targeted therapies. Hematology. 2017; 2017(1): 1-12. doi:10.1182/asheducation-2017.1.1
3. Clinical profile and treatment outcome of older (>75 years) patients with systemic AL amyloidosis | Haematologica. Accessed April 13, 2025. https://haematologica.org/article/view/7560
4. Feitosa VA, Neves PDMM, Jorge LB, Noronha IL, Onuchic LF. Renal amyloidosis: a new time for a complete diagnosis. Braz J Med Biol Res. 2022; 55: e12284. doi:10.1590/1414-431X2022e12284.
5. Palladini G, Milani P, Merlini G. Management of AL amyloidosis in 2020. Blood. 2020; 136(23): 2620-2627. doi:10.1182/blood.2020006913.
6. Dember LM. Amyloidosis-associated kidney disease. J Am Soc Nephrol. 2006; 17(12): 3458-3471. doi:10.1681/ASN.2006050460.
7. Ozawa M, Komatsuda A, Ohtani H, et al. Long-term prognosis of AL and AA renal amyloidosis: a Japanese single-center experience. Clin Exp Nephrol. 2017; 21(2): 212-227. doi:10.1007/s10157-016-1271-y.
8. Hassen M, Bates W, Moosa MR. Pattern of renal amyloidosis in South Africa. BMC Nephrol. 2019; 20(1): 406. doi:10.1186/s12882-019-1601-x.
9. Said SM, Sethi S, Valeri AM, et al. Renal amyloidosis: origin and clinicopathologic correlations of 474 recent cases. Clin J Am Soc Nephrol. 2013; 8(9): 1515-1523. doi:10.2215/CJN.10491012.
10. Merlini G. AL amyloidosis: from molecular mechanisms to targeted therapies. Hematology. 2017; 2017(1): 1-12. doi:10.1182/asheducation-2017.1.1.
11. Guidelines Working Group of UK Myeloma Forum, British Commitee for Standards in Haematology, British Society for Haematology. Guidelines on the diagnosis and management of AL amyloidosis. Br J Haematol. 2004; 125(6): 681-700. doi:10.1111/j.1365-2141.2004.04970.x.
12. Velayati S, Belkin A, Sidhu Kumar G, Tharayil ZJ, Kumar N, Patel S. Kidney-limited AL amyloidosis: a case report and review of the literature. J Community Hosp Intern Med Perspect. 11(5): 698-702. doi:10.1080/20009666.2021.1942624.
13. Fuah KW, Lim CTS. Renal-limited AL amyloidosis - a diagnostic and management dilemma. BMC Nephrol. 2018; 19: 307. doi:10.1186/s12882-018-1118-8.
14. Castano E, Palmer MB, Vigneault C, Luciano R, Wong S, Moeckel G. Comparison of amyloid deposition in human kidney biopsies as predictor of poor patient outcome. BMC Nephrol. 2015; 16: 64. doi:10.1186/s12882-015-0046-0.
15. Nephrotic Syndrome in Adults: Diagnosis and Management. ResearchGate. Published online August 7, 2025. Accessed December 1, 2025. https://www.researchgate.net/publication/38081448_Nephrotic_Syndrome_in_Adults_Diagnosis_and_Management.
16. Novak L, Cook WJ, Herrera GA, Sanders PW. AL-amyloidosis is underdiagnosed in renal biopsies. Nephrol Dial Transplant. 2004; 19(12): 3050-3053. doi:10.1093/ndt/gfh503.
17. Clinicopathological Pattern of Non-lupus Full House Nephropathy - PMC. Accessed December 1, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC7869643/.
18. Agrawal V, Sharma A. Diagnostic Immunostaining of Renal Biopsies: An Overview of Markers for Glomerular Diseases. Glomerular Dis. 2025; 5(1): 176-190. doi:10.1159/000545311.
19. Herrera GA. Renal Diseases Associated with Hematopoietic Disorders or Organized Deposits. In: Nadasdy T, D’Agati VD, Zhou XJ (Joseph), Laszik ZG, eds. Silva’s Diagnostic Renal Pathology. 2nd ed. Cambridge University Press; 2017: 385-448. Accessed December 1, 2025. https://www.cambridge.org/core/books/silvas-diagnostic-renal-pathology/renal-diseases-associated-with-hematopoietic-disorders-or-organized-deposits/3833C1A605E371B61266C98297D03E45.
20. Daratumumab-Based Treatment for Immunoglobulin Light-Chain Amyloidosis | New England Journal of Medicine. Accessed April 19, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa2028631
21. Pinney JH, Lachmann HJ, Bansi L, et al. Outcome in renal Al amyloidosis after chemotherapy. J Clin Oncol. 2011; 29(6): 674-681. doi:10.1200/JCO.2010.30.5235.