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| {{SI}} | | {{SI}} |
| | | '''To go back to the Amyloidosis landing page, click [[Amyloidosis|here]].'''<br> |
| {{CMG}}; {{AE}}{{Homa}} | | {{CMG}}; {{AE}}{{Homa}} |
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| ==Differentiating lysozyme amyloid related amyloidosis from Other Diseases== | | ==Differentiating lysozyme amyloid related amyloidosis from Other Diseases== |
| Lysozyme amyloid related amyloidosis must be differentiated from other types of familial amyloidosis and other diseases that mimic amyloidosis and may present as organ dysfunction, specifically, [[nephrotic syndrome]] leading to [[renal failure]], [[cardiac failure]] and [[polyneuropathy]]. | | Lysozyme amyloid related amyloidosis must be [[Differentiate|differentiated]] from other types of [[familial amyloidosis]] and other [[diseases]] that mimic [[amyloidosis]] and may present as [[Organ (anatomy)|organ]] dysfunction, specifically, [[nephrotic syndrome]] leading to [[renal failure]], [[cardiac failure]] and [[polyneuropathy]]. |
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| {|
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Organ System Involvement}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Differential Diagnosis}}
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Causes}}
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Clinical Features}}
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Therapy}}
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| |-
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| ! rowspan="9" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Nephrotic Syndrome and Real Failure
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Familial Amyloidosis
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Genetic mutation
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Parasthesia
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| * Muscle weakness
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| * Sexual problems
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| * Constipation/ diarrhea
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| * Urination problems
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| * Weakness
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| * Fatigue
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| * Edema
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| * Palpitation
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| * Dizziness
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ncreased:I
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| | |
| :* [[Troponin I]] or [[Troponin T|TroponinT]]
| |
| :* [[BNP]] and [[NT-proBNP]]
| |
| :* [[AST]]
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| :* [[ALT]]
| |
| :* Total [[bilirubin]]
| |
| :* [[Alkaline phosphatase]]
| |
| :* [[Creatinine|Serum creatinine]]
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| :* [[Urinary]] [[protein]]
| |
| :*
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Apple green birefringence of the tissue sample under polarized light with Congo red stain.
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Liver transplant for TTR amyloidosis
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| * Organ specific transplant
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| * Tafamidis
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| * Patisiran and Inoteresen
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| * Diflunisal
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| * Epigallocathechin-3-gallate <br />
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Primary (AL) Amyloidosis
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Monoclonal]] [[plasma cell]] proliferation
| |
| * Extracellular [[amyloid]] fibril deposition
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anasarca]]
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| *[[Bleeding tendency]]
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| * Swelling of [[lower limbs]]
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| * Frothy [[urine]]
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| *[[Chest pain]]
| |
| *[[Numbness]] or [[tingling]]
| |
| *[[Early satiety]]
| |
| *[[Joint pains]]
| |
| *[[Macroglossia|Enlarged tongue]]
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| *[[Taste loss]]
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| *[[Hoarseness|Hoarseness of voice]]
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| *[[Alopecia|Hair loss <br />]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Increased [[erythrocyte sedimentation rate]] ([[ESR]])
| |
| * Increased [[Alanine aminotransferase|alanine aminotrasnferase]] ([[Alanine transaminase|ALT]]) and [[Aspartate aminotransferase|aspartate aminotrasnferase]] ([[Aspartate transaminase|AST]])
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| * Increased [[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponins]]
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| * Increased [[brain natriuretic peptide]] ([[BNP]])
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| * Increased [[blood urea nitrogen]] ([[BUN]]) and [[creatinine]]
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| *[[Proteinuria]]
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| * Urinary [[Hyaline cast|hyaline]] and fatty casts
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| *[[Hypercholesterolemia]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Diffuse glomerular deposition of amorphous [[hyaline]] material (nodular pattern - 8 to15 nm in diameter), in [[mesangium]] (weakly staining with [[Periodic acid-Schiff stain|periodic acid-Schiff]] ([[Periodic acid-Schiff stain|PAS]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Melphalan]]-[[prednisone]]/[[dexamethasone]]
| |
| *[[Dexamethasone]] plus [[Cyclophosphamide]]-[[thalidomide]]
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| *[[Stem cell transplantation]]
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| *[[Kidney transplantation]]
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| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Diabetic nephropathy|Diabetic Nephropathy]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Hyperfiltration
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| * Constriction of [[efferent arteriole]]
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| *[[Microalbuminuria]]
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| *[[Mesangial cell|Mesangial]] proliferation
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Nocturia]]
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| *[[Fatigue]]
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| *[[Pruritis]]
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| *[[Peripheral edema]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Hyperglycemia]] (random plasma glucose ≥200 mg/dL)
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| *[[Proteinuria]]
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| *[[Glucosuria]]
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| *[[Glycosylated hemoglobin|HbA1C]] ≥6.5% (48 mmol/mol). <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
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| **[[Periodic acid-Schiff stain|PAS]] positive [[Kimmelstiel-Wilson syndrome|Kimmelstiel-Wilson nodules]]
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| **[[Glomerulosclerosis]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[ACE inhibitor|ACE inhibitors]]
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| *[[Angiotensin receptor blockers]]
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| *[[Glycemic]] control
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| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Minimal change disease|Minimal Change Disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Upper respiratory tract infection]]
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| *[[Allergy]] to bee sting
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| *[[Non-steroidal anti-inflammatory drug|NSAID]]
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| *[[Gold]]
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| *[[Penicillamine]]
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| *[[Ampicillin]]
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| *[[Mercury (element)|Mercury]]
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| *[[Hodgkin's lymphoma|Hodgkin's]] and [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Peripheral edema]]
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| *[[Hypertension]]
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| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
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| *[[Hypertension]]
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| *[[Hyperlipidemia]]
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| *[[Hypoalbuminemia]]
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| *[[Microscopic hematuria]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Fused [[podocytes]]/effacement
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]] with taper
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| *[[ACE inhibitor|ACE inhibitors]]
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| *[[Angiotensin receptor blockers]]
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| * Salt restriction
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| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Focal segmental glomerulosclerosis|Focal Segmental Glomerulosclerosis]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[HIV]]
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| *[[Parvovirus B19]]
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| *[[Cytomegalovirus]]
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| *[[Heroin]]
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| *[[Interferon alpha]]
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| *[[Lithium]]
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| *[[Pamidronate]]/aledronate
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| *[[Anabolic steroids]]
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| *[[Diabetes mellitus]]
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| *[[Hypertension]]
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| *[[Obesity]]
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| *[[Congenital heart disease cyanotic|Cyanotic congenital heart disease]]
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| *[[Sickle cell anemia]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Peripheral edema]]
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| *[[Hypertension]]
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| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
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| *[[Hypertension]]
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| *[[Hyperlipidemia]]
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| *[[Hypoalbuminemia]]
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| *[[Microscopic hematuria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
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| **[[Podocytes|Podocyte]] foot process effacement
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| **[[Capillary]] lumen abolished by the segmental increase in matrix <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]]
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| *[[Calcineurin inhibitor|Calcineurin inhibitors]] ([[Cyclosporine|Cyclosporin]], [[tacrolimus]])
| |
| *[[Rituximab]]
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| *[[Cyclophosphamide]]/[[chlorambucil]]
| |
| *[[Mycophenolate|Mycophenolate motefil]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Fabry's disease|Fabry's Disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Deficient alpha galactosidase A
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Abdominal pain]]
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| *[[Arthralgia]]
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| *[[Febrile]] episodes
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| *[[Angiokeratomas]]
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| * Burning pain and tingling ([[Peripheral neuropathy|peripheral neuropathy)]]
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| *[[Hypohidrosis]]
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| *[[X-linked recessive]] inheritance
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Deficient alpha galactosidase A
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| * Increased ceramide trihexoside ([[Globotriaosylceramide 3-beta-N-acetylgalactosaminyltransferase|globotriaosylceramide]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Alpha-galactosidase A activity
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| *[[GLA|GLA gene]] analysis for [[Heterozygote|heterozygotes]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Enzyme replacement therapy
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| *[[ACE inhibitor|ACE inhibitors]]
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| *[[Gabapentin]], [[carbamazepine]]
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| *[[Migalastat]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Light Chain Deposition Disease
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Multiple myeloma]]
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| *[[Waldenström's macroglobulinemia]]
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| *[[Monoclonal gammopathy of undetermined significance]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| *[[Fatigue]]
| |
| *[[Weight loss]]
| |
| *[[Dyspnea]]
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| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
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| *[[Portal hypertension]]
| |
| * Increased [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
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| ** Non-amyloid granules
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Bortezomib]]
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| * Autologous [[stem cell transplantation]]
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| * Immunomodulatory drugs
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| *[[Kidney transplantation|Kidney transplant]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Membranous glomerulonephritis|Membranous Glomerulonephritis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hepatitis B]] and [[Hepatitis C|C]]
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| *[[HIV]]
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| *[[Non-Hodgkin lymphoma|Non-Hodgkin`s lymphoma]]
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| *[[Chronic lymphocytic leukemia]]
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| *[[Hodgkin lymphoma|Hodgkin`s lymphoma]]
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| * Solid tissue tumors
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| *[[Schistosomiasis]]
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| *[[Leprosy]]
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| *[[Hydatid disease]]
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| *[[Loaiasis]] (filaria)
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| *[[Malaria|Quartan malaria]]
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| *[[Systemic lupus erythematosis]] ([[SLE]]) <br />
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| | style="padding: 5px 5px; background: #F5F5F5;" |<br />
| |
| | |
| *[[Headache]]
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| *[[Edema]] affecting any area of the body
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| * Foamy appearance of urine
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| *[[Weight gain]]
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| *[[Poor appetite]]
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| *[[Nocturia]]
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| *[[Fatigue]]
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| *[[Hematuria]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
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| *[[Hypertension]]
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| *[[Hyperlipidemia]]
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| *[[Hypoalbuminemia]]
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| * Microscopic or gross hematuria
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| *[[Hypoalbuminemia]]
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| *[[Antinuclear antibodies|ANA]] and [[Anti-dsDNA antibody|anti-dsDNA]] positivity
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
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| **[[Immunoglobulin G|IgG]] and [[C3 (complement)|C3]] deposits with thickened [[basement membrane]] with spikes and vacuolization
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| **[[Glomerulosclerosis]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]]
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| *[[Methylprednisolone]] with [[cyclophosphamide]]
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| *[[Tacrolimus]] with a six-month taper
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| *[[Rituximab]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Fibrillary-Immunotactoid Glomerulopathy
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Idiopathic]]
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| *[[Hepatitis C]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| * Microscopic or [[Hematuria|gross hematuria]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Proteinuria]]
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| *[[Hypertension]]
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| *Increased [[blood urea nitrogen]] ([[Blood urea nitrogen|BUN]]) and [[creatinine]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
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| ** Polycloncal [[Immunoglobulin G|IgG]] deposits
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| ** Infiltration of glomerular structures by amorphous acellular material (nonbranching fibrils 12-24nm in diameter)
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| ** Ig heavy-chain and one light-chain subclass
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| |-
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| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Organ System Involvement}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Differential Diagnosis}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Causes}}
| |
| ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF| Clinical Features}}
| |
| ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Therapy}}
| |
| |-
| |
| | rowspan="6" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Polyneuropathy'''''
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[POEMS syndrome]] (Demyelinating)'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Monoclonal]] [[plasma cell]] proliferation
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| *[[Cytokine]] storm ([[IL-1]], [[Interleukin 6|IL-6]], [[Interleukin 12|IL-12]], [[TNF alpha]], [[VEGF]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Symmetrical, ascending chronic progressive [[polyneuropathy]] with both [[Sensory system|sensory]] (pin-prick and vibration) and [[Motor skill|motor]] disability ([[Motor skill|motor]] > [[sensory]])
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| * Generalized/extermity [[pain]]
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| *[[Areflexia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Increased number of [[Platelet|thrombocytes]]
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| *Increased number of [[Red blood cell|erythrocytes]]
| |
| *Elevated [[Cerebrospinal fluid|cerebrospinal fluid (CSF)]] [[protein]] content
| |
| *Increased number of [[White blood cells|leukocytes]]
| |
| *High levels of [[Immunoglobulin G|IgG]] lambda or [[Immunoglobulin A|IgA]] lambda [[M protein|M-protein]] in the [[serum]]
| |
| *Increased number of [[Plasma cell|plasma cells]] in the [[bone marrow]]
| |
| *Increased serum [[Vascular endothelial growth factor|VEGF]] level
| |
| *Elevated levels of antitiroglobulin [[antibody]] and antithyroid peroxydase [[antibody]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[POEMS syndrome diagnostic criteria|International Myeloma Working Group (IMWG) clinical and laboratory diagnostic criteria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Metabolic syndrome|Metabolic Syndrome]] (Axonal pathology)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Diabetes mellitus]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Symmetric sensorimotor distal polyneuropathy
| |
| * Asymmetric proximal neuropathy
| |
| *[[Oculomotor nerve palsy|3rd nerve palsy]]
| |
| *[[Carpal tunnel syndrome|Carpel tunnel syndrome]]
| |
| *[[Autonomic neuropathy]]
| |
| * "Glove and stocking" type pain
| |
| *[[Muscle wasting]]
| |
| *[[Hammer toe|Hammer toes]]
| |
| *[[Polyuria]]
| |
| *[[Polydipsia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Uncontrolled [[hyperglycemia]]
| |
| * Slowed [[Nerve conduction study|nerve conduction]]
| |
| *[[Small fiber peripheral neuropathy|Small fiber dysfunction]]
| |
| *[[Monofilament|Monofilament testing]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fasting blood sugar|Fasting blood sugar level]] greater than equal to 126 mg/dl on 2 separate occasions
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Diabetes mellitus medical therapy|Anti-diabetic therapy]]
| |
| *[[Gabapentin]]
| |
| *[[Carbamazepine]]
| |
| *[[Foot care]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Vitamin deficiencies|Vitamin Deficiencies]] (Axonal Pathology)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin B12 deficiency]] (Decreased [[S-Adenosyl methionine|S-adenosyl methionine]])
| |
| *[[Thiamine deficiency|Vitamin B1 deficiency]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Primarily [[sensory]] deficits
| |
| * Vibration and [[proprioception]] affected
| |
| *[[Gait abnormality|Gait abnormalities]]
| |
| *[[Cognitive impairment]]
| |
| *[[Irritability]]
| |
| *[[Glossitis]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anemia]] ([[Megaloblastic Anemias|megaloblastic]] in case of [[Vitamin B12 deficiency|B12 deficiency]])
| |
| * Decreased [[serum]] [[Vitamin B12]] levels (< 200 pg/ml)
| |
| *[[Methylmalonic acidemia|Elevated methylmalonic acid]]
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Serum]] [[Vitamin B12]] levels
| |
| *[[Methylmalonic acid|Methylmalonic acid levels]]
| |
| *[[Intrinsic factor|Intrinsic factor antibodies]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin B12]] supplement ([[parenteral]])
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Guillain-Barré syndrome|Guillain-Barre Syndrome]] (Demyelinating)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anti-ganglioside antibodies|Anti-ganglioside]] and anti-[[myelin]] antibodies
| |
| *[[Viral]] infections:
| |
| **[[Epstein Barr virus]]
| |
| **[[Human Immunodeficiency Virus (HIV)|HIV]]
| |
| **[[Cytomegalovirus]]
| |
| **[[Varicella Zoster Virus|Varicella Zoster virus]]
| |
| *[[Bacterial]] infections:
| |
| **[[Campylobacter]] infection
| |
| **[[Mycoplasma pneumoniae]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Rapid onset and quick progression
| |
| * Progression stops after 2-3 weeks
| |
| * Bilateral ascending [[Paraesthesia|paraesthesias]] and [[paralysis]] (generalized)
| |
| *[[Muscle weakness|Weakness]]
| |
| *[[Ataxia]]
| |
| *[[Areflexia]]
| |
| * No fever
| |
| * 4 sub-types:
| |
| **[[Acute inflammatory demyelinating polyneuropathy]]
| |
| **[[Acute motor axonal neuropathy]]
| |
| **Acute motor and sensory axonal neuropathy
| |
| **[[Miller Fisher syndrome]]
| |
| | |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Delayed F waves
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Clinical diagnostic criteria (progressive weakness of more than two [[limbs]], [[areflexia]], and progression for no more than four weeks)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Intravenous]] [[immunoglobulins]]
| |
| *[[Plasma]] exchange
| |
| *[[Mechanical ventilation|Respiratory support]]
| |
| *[[DVT]]/[[PE]] [[prevention]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Chronic inflammatory demyelinating polyneuropathy|Chronic Inflammatory Demyelinating Polyneuropathy]] (CIDP) (Mixed axonal and demyelinatiing)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Abnormal [[immune response]] (both [[Immunoglobulin G|IgG]] based [[Humoral immunity|humoral]] and [[Cell mediated immunity|T-Cell mediated]]) response to unknown [[antigen]] (possible culprits include [[myelin]] [[proteins]] P0, P2 and PMP22)
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Slow onset and gradual progression
| |
| *[[Relapse|Relapsing]] and remitting course
| |
| * Symmetrical [[Proximal muscle weakness|proximal]] and [[Distal muscle weakness|distal motor]] and [[Sensory system|sensory weakness]] (legs>arms)
| |
| *[[Foot drop]]
| |
| *[[Numbness]], [[tingling]] and [[pain]]
| |
| *[[Areflexia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Elevated [[CSF]] [[protein]] ([[oligoclonal bands]] with normal [[White blood cells|WBCs]])
| |
| * Slowed [[Nerve conduction study|motor nerve conduction velocities]]
| |
| * Prolonged distal [[Motor skill|motor]] latencies (period between F wave and initial stimulation)
| |
| * Delayed F wave latencies (recorded from the [[feet]], hence called "F" waves)
| |
| *[[MRI]] contrast enhancement and enlargement of [[Vertebra|T2]] [[spinal segments]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * EFNS/PNS criteria
| |
| * Koski criteria
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Corticosteroids]]
| |
| *[[Intravenous immunoglobulin]] ([[IVIG]])
| |
| *[[Immunosupressive drug|Immunosupressants]] ([[Alemtuzumab|Alemtuzemab]] [[Azathioprine]] [[Cyclophosphamide]] [[Cyclosporine|Cyclosporin]] [[Etanercept]] [[Interferon-alpha]])
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multifocal motor neuropathy|Multifocal Motor Neuropathy]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Immune response|Abnormal immune response]] ([[Anti-ganglioside antibodies|Anti ganglioside]] [[Anti-ganglioside antibodies|GM-1]] [[IgM]] [[antibodies]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Progressive, asymmetric, distal and upper [[Limb (anatomy)|limb]] predominant weakness
| |
| * No significant [[sensory]] abnormalities
| |
| *[[Areflexia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Elevated [[CSF]] [[protein]]
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Clinical criteria (EFNS/PNS):
| |
| ** Slowly progressive or step-wise progressive, focal, asymmetric [[limb]] weakness; i.e., [[Motor skill|motor]] involvement in the [[motor nerve]] distribution of at least two nerves for > 1 month.
| |
| ** No objective [[Sensory system|sensory]] abnormalities except for minor vibration sense abnormalities in the [[lower limbs]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Intravenous immunoglobulin|Intravenous immunoglobulins]]
| |
| *[[Cyclophosphamide]]
| |
| *[[Rituximab]]
| |
| |-
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Organ System Involvement'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Differential Diagnosis'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Causes'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Features'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Therapy'''}}
| |
| |-
| |
| | rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Organomegaly (Hepatosplenomegaly and Lymphadenopathy)'''''
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Malaria]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Plasmodium falciparum]]
| |
| *[[Plasmodium ovale|P. ovale]]
| |
| *[[P. malariae]]
| |
| *[[Plasmodium knowlesi|P. knowlesi]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Tertian ([[Plasmodium vivax|vivax]], [[Plasmodium ovale|ovale]], [[Plasmodium falciparum|falciparum]]), quartan (malariae), quotidian fever ([[Plasmodium knowlesi|knowlesi]])
| |
| *[[Vector]] is female [[Anopheles]] mosquito
| |
| *[[Hepatosplenomegaly]]
| |
| *[[Lymphadenopathy]]
| |
| *[[Jaundice]]
| |
| *[[Icterus (medicine)|Icterus]]
| |
| *[[Tachycardia]]
| |
| *[[Tachypnea]]
| |
| *[[Productive cough]]
| |
| *[[Hematuria]]
| |
| *[[Altered mental status]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Microcytic anemia]]
| |
| *[[Malaria differential diagnosis|Thick and thin blood films]] ([[Giemsa stain|Giemsa staining]])
| |
| | |
| * Rapid diagnostic test ([[antigen]] detection
| |
| *[[Polymerase chain reaction]] ([[Polymerase chain reaction|PCR]])
| |
| *[[Enzyme linked immunosorbent assay (ELISA)|Enzyme linked immunosorbent assay]] ([[Enzyme linked immunosorbent assay (ELISA)|ELISA]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Malaria differential diagnosis|Thick and thin films]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Non-[[Plasmodium falciparum|falciparum]] species:
| |
| **[[Chloroquine]] (in susceptible)
| |
| **[[Artemisinin]] plus [[Mefloquine|mefloquin]] or [[lumefantrine]] (in [[chloroquine]] resistant)
| |
| *[[Plasmodium falciparum|Falciparum]] species:
| |
| **[[Chloroquine]] (in susceptible)
| |
| **[[Artemether]] plus [[lumefantrine]] (in [[Chloroquine|chloroquin]] resistant) OR
| |
| **[[Artesunate]] plus [[Mefloquine|mefloquin]] OR
| |
| **[[Artesunate]] plus [[Sulfadoxine|sulfadoxine-pyrimethamine]]
| |
| **[[Atovaquone-Proguanil|Atovaquone plus proguanil]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Kala-azar]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Leishmaniasis|Leshmania donovani]]
| |
| * L. infantum
| |
| * L. chagasi
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fever]]
| |
| * Vector is [[sandfly]]
| |
| *[[Hepatosplenomegaly]]
| |
| *[[Lymphadenopathy]]
| |
| *[[Hyperpigmentation]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anemia]]
| |
| *[[Direct agglutination test]] (DAT)
| |
| * rk39 dipstick
| |
| *[[Enzyme linked immunosorbent assay (ELISA)|ELISA]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Splenic]] aspiration
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Liposomal amphotericin B]]
| |
| *[[Sodium stibogluconate]]
| |
| *[[Pentamidine]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Hepatitis|Infective Hepatitis]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hepatitis A virus|Hepatitis A virus (HAV)]]
| |
| *[[HBV]]
| |
| *[[Hepatitis C|HCV]]
| |
| *[[Hepatitis D|HDV]] (co-infection with [[HBV]])
| |
| *[[Hepatitis E|HEV]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fever]]
| |
| * Transmitted via [[fecal-oral route]] ([[Hepatitis A|HAV]], [[Hepatitis B virus|HBV]], [[HDV]], [[HEV]]), infected sera ([[HCV]]), [[sexual contact]] with infected individuals
| |
| *[[Hepatosplenomegaly]] (may become shrunken in cases of [[cirrhosis]] due to chronic infection)
| |
| *[[Lymphadenopathy]]
| |
| *[[Jaundice]]
| |
| *[[Palmar erythema]]
| |
| *[[Spider angiomata]]
| |
| *[[Gynecomastia]]
| |
| *[[Arthritis-dermatitis syndrome]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Antigen]] and [[antibody]] detection
| |
| * Total and direct [[bilirubin]] (increased)
| |
| * Severe disease is often associated with persistent [[bilirubin]] levels >340 mmol/L
| |
| *[[ALT]] and [[AST]] (increased)
| |
| *[[Alkaline phosphatase]] (normal or mildly elevated)
| |
| *[[Prothrombin time]] (prolonged from synthetic defect, caused by hepatocellular [[necrosis]])
| |
| *[[Total protein]] (decreased)
| |
| *[[Globulin]] (mildly elevated)
| |
| * Initial [[lymphopenia]] and [[neutropenia]], followed by relative [[lymphocytosis]]
| |
| *[[Anemia|Low hemoglobin]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Antigen]] and [[antibody]] detection
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Interferon]] ([[IFN]])
| |
| | |
| *[[Antivirals|Nucleoside analogs]]
| |
| | |
| *[[Antivirals|Nucleotide analogs]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Chronic myelogenous leukemia|Chronic Myelogenous Leukemia]] (CML)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Philadelphia chromosome|BCR/ABL gene]] fusion product due to [[Chromosomal translocation|translocation]] [[mutation]] [[Philadelphia chromosome|t(9;22)]](q34;q11)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fever]]
| |
| *[[Weight loss]]
| |
| *[[Hepatosplenomegaly]]
| |
| *[[Lymphadenopathy]]
| |
| | |
| *[[Bruises]]
| |
| *[[Petechiae]]
| |
| *[[Ulcers]]
| |
| *[[Vesicles]]
| |
| *[[Malaise]]
| |
| *[[Early satiety]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anemia]]
| |
| | |
| *[[Leukocytosis]] (median of 100,000/µL) with a [[left shift]]
| |
| *[[Thrombocytosis]]
| |
| *[[Blast|Blasts]] usually <2%
| |
| * Absolute [[basophilia]]
| |
| * Absolute [[eosinophilia]]
| |
| *[[Monocytosis]]
| |
| *[[Thrombocytosis]]
| |
| *[[Thrombocytopenia]] suggests an alternative diagnosis or the presence of advanced stage
| |
| * Elevated [[uric acid]]
| |
| * Elevated [[histamine]] levels
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fluorescence in situ hybridization|Fluoroscent insitu hybridization (FISH)]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Imatinib]]
| |
| *[[Dasatinib]]
| |
| *[[Nilotinib]]
| |
| *[[Bosutinib]]
| |
| *[[Ponatinib]]
| |
| | |
| *[[Cytarabine]]
| |
| *[[Cytarabine|HDAC]] (high-dose [[cytarabine]])
| |
| *[[Hydroxyurea]]
| |
| *[[Busulfan]]
| |
| *[[Busulfex]]
| |
| *[[Stem cell transplantation]]
| |
| | |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Lymphoma]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Various causes based on type:
| |
| **[[Hodgkin's lymphoma|Hodgkin's]]
| |
| **[[Non-Hodgkin lymphoma|Non-Hodgkin's]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Fever]]
| |
| *[[Weight loss]]
| |
| *[[Lymphadenopathy]]
| |
| *[[Hepatosplenomegaly]]
| |
| *[[Night sweats]], constant [[fatigue]]
| |
| * Purplish scaly rash in cases of [[cutaneous lymphoma]]
| |
| | |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Erythrocyte sedimentation rate|Elevated ESR]]
| |
| *[[C-reactive protein|Increased CRP]]
| |
| *[[Lactate dehydrogenase|Increased LDH]]
| |
| *[[Anemia of chronic disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Lymph node biopsy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Primary amyloidosis|Primary (AL) Amyloidosis]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Aggregation and deposition of [[immunoglobulin light chains]] that are usually produced by [[plasma cell]] clones
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Nephrotic syndrome]] ([[peripheral edema]])
| |
| *[[Restrictive cardiomyopathy]] ([[fatigue]], [[dyspnea]], [[syncope]])
| |
| *[[Peripheral neuropathy]] ([[numbness]], [[tingling]])
| |
| *[[Hepatomegaly]] with elevated [[liver enzymes]]
| |
| *[[Macroglossia]]
| |
| *[[Purpura]]
| |
| *[[Bleeding diathesis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Typical green birefringence under polarized light after Congo red staining (appears in red under normal light)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Congo red staining
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Melphalan-prednisone/dexamethasone
| |
| * Dexamethasone plus Cyclophosphamide-thalidomide
| |
| * Stem cell transplantation
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Gaucher's disease|Gaucher's Disease]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[GBA (gene)|GBA gene]] [[mutation]]
| |
| * Aberrant metabolism of [[glucocerebroside]] ([[lipid]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hydrops fetalis]]
| |
| * Dry, scaly skin ([[ichthyosis]]) or other [[skin]] abnormalities
| |
| *[[Hepatosplenomegaly]]
| |
| * Distinctive facial features
| |
| *[[Neurological disorder|Neurological problems]]
| |
| *[[Gall stones]]
| |
| *[[Growth retardation]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hypocholesterolemia]]
| |
| *[[Splenic]] nodules
| |
| *[[Cytopenias]] (especially [[thrombocytopenia]])
| |
| * Increased [[ferritin]] levels
| |
| * Increased tartarate resistant acid phosphatase (TRAP) levels
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Enzyme assay for [[glucocerebrosidase]]
| |
| *[[DNA|DNA analysis]] for [[GBA (gene)|GBA mutation]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Enzyme replacement therapy|Enzyme replacement]]
| |
| *[[Splenectomy]]
| |
| *[[Blood transfusion]]
| |
| |-
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| |'''Organ System Involvement'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Differential Diagnosis'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Causes'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Features'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Therapy'''}}
| |
| |-
| |
| | rowspan="5" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Cardiac Failure'''''
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Cardiac amyloidosis (AL and ATTRwt)
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Monoclonal plasma cell proliferation
| |
| * Extracellular amyloid fibril deposition <br />
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Fatigue
| |
| * Dyspnea
| |
| * Dizziness
| |
| * Orthopnea
| |
| * Peripheral edema
| |
| * Weight loss due to cardiac cachexia
| |
| * Ascites
| |
| * Syncope on exertion
| |
| * Transthyretin (ATTRwt) associated more common in African-Americans during sixth to seventh decade of life
| |
| | |
| **
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Normocytic mormochromic anemia
| |
| * Serum free-light-chain assay positive
| |
| * Increased BNP, ANP and β2 microglobulin
| |
| * Voltage-to-mass ratio is more sensitive than EKG, 2D Echo and nuclear scanning alone <br />
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| | |
| * Diffuse deposition of amorphous hyaline material (nodular pattern - 8 to15 nm in diameter), in mesangium (weakly staining with periodic acid-Schiff (PAS)
| |
| | |
| <br />
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Supportive care
| |
| * Tafamidis
| |
| * Melphalan-prednisone/dexamethasone
| |
| * Dexamethasone plus Cyclophosphamide-thalidomide
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hypertrophic obstructive cardiomyopathy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Mutations|Mutation]] in sarcomeric protein (beta myosin heavy chain and myosin binding protein C)
| |
| *[[Autosomal dominant]] inheritance
| |
| | |
| *
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |<br />
| |
| | |
| * [[Chest pain]] (also known as [[Angina pectoris|angina]])
| |
| * [[Dizziness]]
| |
| * [[Dyspnea]] ([[shortness of breath]]) which is due to increased stiffness of the [[hypertrophied left ventricle]]
| |
| * [[Exercise intolerance]]
| |
| * [[Fainting]], [[presyncope]] or frank [[syncope]], especially during exercise
| |
| * [[Fatigue]])
| |
| * [[Light-headedness]]
| |
| * [[Shortness of breath]]
| |
| * [[Reduced activity tolerance]]
| |
| * [[Shortness of breath]]
| |
| * [[Sudden cardiac death]]
| |
| | |
| <br />
| |
| | |
| **
| |
| **
| |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
| * Increased [[Brain natriuretic peptide|BNP]]
| |
| * Increased [[creatine kinase]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Echocardiography:
| |
| ** [[Left ventricular]] asymmetric hypertrophy
| |
| ** Parasternal long axis shows relationship of the septal hypertrophy and the outflow tract
| |
| ** Left ventricular diastolic dysfunction
| |
| ** SAM (systolic anterior motion) of the mitral leaflet
| |
| ** Mid-systolic closure of the aortic valve
| |
| ** Late peaking, high velocity flow in the outflow tract
| |
| ** Variability of obstruction with maneuvers (exercise, amyl nitrate inhalation, and post-PVC beats) <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Beta blockers]]
| |
| * [[Calcium channel blocker|Calcium channel blockers]]
| |
| * [[Septal myectomy]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Alcoholic cardiomyopathy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Alcohol consumption
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Exercise intolerance]]
| |
| *[[Fainting]], [[presyncope]] or frank [[syncope]], especially during exercise
| |
| *[[Fatigue]])
| |
| *[[Light-headedness]]
| |
| *[[Shortness of breath]]
| |
| *[[Reduced activity tolerance]]
| |
| *[[Shortness of breath]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |<br />
| |
| | |
| * Elevated [[mean corpuscular volume]] ([[MCV]]) and [[mean corpuscular hemoglobin]] (MCHC)
| |
| * Mild [[thrombocytopenia]]
| |
| * Elevated [[LDH]], [[AST]], [[ALT]], [[creatine kinase]], malic dehydrogenase and alpha-hydroxybutyric dehydrogenase
| |
| * Elevated gammaglutamyl transpeptidase
| |
| * Serum concentrations of [[magnesium]] and [[zinc]] may be reduced
| |
| | |
| <br />
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Endomyocardial biopsy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Restriction of dietary salt
| |
| * [[ACE inhibitor|ACE inhibitors]] or [[angiotensin II receptor blockers]]
| |
| * [[Beta blockers]]
| |
| * [[Diuretics]]
| |
| * [[Digoxin]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[ST elevation myocardial infarction|ST-elevation myocardial infarction]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Myocardial ischemia]]
| |
| * [[Atherosclerosis]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Exercise intolerance]]
| |
| *[[Fainting]], [[presyncope]] or frank [[syncope]], especially during exercise
| |
| *[[Fatigue]])
| |
| *[[Light-headedness]]
| |
| *[[Shortness of breath]]
| |
| *[[Reduced activity tolerance]]
| |
| *[[Shortness of breath]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Increased [[Cardiac troponin|cardiac troponins]]
| |
| * Increased [[Lactate dehydrogenase|LDH]]
| |
| * [[Leukocytosis]]
| |
| * [[ST segment elevation]] on EKG
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Elevation of [[Cardiac troponin|cardiac troponins]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Percutaneous coronary intervention or coronary artery bypass graft
| |
| * [[Aspirin]]
| |
| * [[Clopidogrel]]
| |
| * [[Beta blockers]]
| |
| * [[Diuretics]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Pericarditis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[HIV]]
| |
| * [[Dressler's syndrome]]
| |
| * [[Tuberculosis]]
| |
| * [[Uremia]]
| |
| * [[Radiation]]
| |
| * [[Malignancy]]
| |
| | |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | |
| * [[Chest pain]] (relieved by sitting up and leaning forward and is worsened by lying down)
| |
| * [[Cough]] (either dry or productive)
| |
| * [[Fever]]
| |
| * [[Fatigue]]
| |
| * [[Anxiety]]
| |
| * [[Breathlessness]]
| |
| | |
| <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | |
| * [[Creatine kinase]]: [[Acute pericarditis]] may be associated with a modest increase in serum [[creatine kinase]]-MB (CK-MB) depending upon the extent of involvement of the underlying [[myocardium]].
| |
| * Increased [[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponin-I (cTnI)]]
| |
| * Increased [[LDH]]
| |
| * Increased serum [[myoglobin]]
| |
| * Increased [[SGOT]] ([[AST]])
| |
| | |
| <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Two of the following four criteria:
| |
| ** Pericarditic chest pain
| |
| ** [[Pericardial rubs|Pericardial rub]]
| |
| ** New widespread [[ST-segment elevation]] or [[PR depression]]
| |
| ** New or worsening [[pericardial effusion]].
| |
| * Supporting findings can include elevation of inflammatory markers ([[C-reactive protein (CRP)|C-reactive protein]], [[Erythrocyte sedimentation rate|ESR]], [[white blood cell count]]), and evidence of pericardial inflammation on imaging([[Computed tomography|CT scan]] and [[cardiac MRI]]).
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| |-
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Organ System Involvement'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Differential Diagnosis'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Causes'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Features'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Therapy'''}}
| |
| |-
| |
| | rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Plasma Cell Dyscrasias'''''
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple myeloma]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Diffuse [[bone]] pain and [[tenderness]] with [[osteolytic]] lesions
| |
| *[[Renal failure]]
| |
| *[[Hypercalcemia]]
| |
| *[[Anemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anemia]]
| |
| *[[Thrombocytopenia]]
| |
| *[[Leukopenia]]
| |
| * Decreased albumin (reversed albumin:globulin ratio)
| |
| * Increased serum creatinine, urea
| |
| * Hypercalcemia
| |
| * Elevated ESR
| |
| * Normal-low alkaline phosphatase
| |
| * RBC rouleaux formation
| |
| * Bence-Jones proteins in urine
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Clonal plasma cells on bone marrow exam greater than equal to 10%
| |
| | |
| AND
| |
| | |
| * Any one of the following:
| |
| ** Evidence of end-organ damage
| |
| ** Hypercalcemia (>11 mg/dl)
| |
| ** Renal insufficiency
| |
| ** Anemia (Hb < 10 mg/dl)
| |
| ** Bone lesions
| |
| ** Greater than 1 lesions on MRI
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Induction [[chemotherapy]] with [[bortezomib]], [[lenalidomide]], and [[dexamethasone]]
| |
| *[[Bisphosphonates]]
| |
| *[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
| |
| *[[Autologous bone marrow transplantation|Autologous stem cell transplantation]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Serum]] [[M protein]] of <3 g/L
| |
| * Fewer than 10% [[plasma cells]] in the [[bone marrow]]
| |
| * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Serum M protein (IgG or IgA) <3g/dl
| |
| | |
| AND
| |
| | |
| * Clonal bone marrow plasma cells < 10%
| |
| | |
| AND
| |
| | |
| * No end-organ damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Observation
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple Myeloma|Asymptomatic Plasma Cell Myeloma]]'''
| |
| [[Multiple Myeloma|('''Smoldering''' and '''Indolent plasma cell myeloma''')]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Serum]] [[M protein]] of greater than equal to 3 g/L
| |
| * Greater than 10% [[plasma cells]] in the [[bone marrow]]
| |
| * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Serum M protein (IgG or IgA greater than equal to 3 g/dl
| |
| | |
| OR
| |
| | |
| * Urinary M protein greater than equal to 500 mg/24 h
| |
| | |
| AND/OR
| |
| | |
| * Clonal bone marrow plasma cells 10-60%
| |
| | |
| AND
| |
|
| |
|
| * No end-organ damage
| | For more information on the differential diagnosis of lysozyme amyloid related amyloidosis [[Familial amyloidosis differential diagnosis|click here]] |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Observation
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasmacytoma]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Solitary bone [[plasmacytoma]] ([[bone]])
| |
| * Extramedullary [[plasmacytoma]] ([[Soft tissue|soft tissues]])
| |
| * Clinical manifestations related to [[tumor]] mass and compression [[symptoms]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" | | |
| * On biopsy:
| |
| ** Solitary infiltrate of clonal plasma cells in bone (SBP) or soft tissue (EMP).
| |
| ** No evidence of infiltration by clonal plasma cells.
| |
| * Negative skeletal survey plus MRI/CT spine and pelvis except for the solitary lesion.
| |
| * Lack of hypercalcemia, renal insuffieciency, anemia, multiple bone lesions which would suggest MM
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Diagnosis of exclusion
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Radiotherapy
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin Changes
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Scurvy]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin C]] deficiency
| |
| *[[Malabsorption]]
| |
| *[[Hemodialysis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Gum disease]] such as gum [[bleeding]]
| |
| *Loose [[teeth]]
| |
| *Easy [[bruising]]
| |
| *Impaired [[immune]] response
| |
| *Impaired [[wound]] healing
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin C]] supplementation
| |
| *Citrus fruits
| |
| |}
| |
|
| |
|
| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| Line 1,150: |
Line 154: |
| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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