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The [[diagnostic]] study of choice in amyloidosis is [[Tissue (biology)|tissue]] [[biopsy]] of the affected [[Organ (anatomy)|organ]]. [[Urinary]] protein measurement followed by [[renal]] [[biopsy]] is the gold standard of the [[diagnosis]]. | The [[diagnostic]] study of choice in amyloidosis is [[Tissue (biology)|tissue]] [[biopsy]] of the affected [[Organ (anatomy)|organ]]. [[Urinary]] protein measurement followed by [[renal]] [[biopsy]] is the gold standard of the [[diagnosis]]. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
* Since AA amyloidosis is a [[condition]] that occurred due to another [[illness]], the [[diagnostic]] study of choice varies according to the primary [[disorder]]. | * Since AA amyloidosis is a [[condition]] that occurred due to another [[illness]], the [[diagnostic]] study of choice varies according to the primary [[disorder]].<ref name="LachmannGoodman2007">{{cite journal|last1=Lachmann|first1=Helen J.|last2=Goodman|first2=Hugh J.B.|last3=Gilbertson|first3=Janet A.|last4=Gallimore|first4=J. Ruth|last5=Sabin|first5=Caroline A.|last6=Gillmore|first6=Julian D.|last7=Hawkins|first7=Philip N.|title=Natural History and Outcome in Systemic AA Amyloidosis|journal=New England Journal of Medicine|volume=356|issue=23|year=2007|pages=2361–2371|issn=0028-4793|doi=10.1056/NEJMoa070265}}</ref> | ||
* However, the amyloidosis itself should be confirmed through [[histologic]] examination of the affected organs. | * However, the amyloidosis itself should be confirmed through [[histologic]] examination of the affected organs. | ||
* A [[Tissue (biology)|tissue]] [[biopsy]] of the affected organ is the [[Gold standard (test)|gold standard test]] for amyloidosis. Particular stains can determine the subtype of amyloidosis. | * A [[Tissue (biology)|tissue]] [[biopsy]] of the affected organ is the [[Gold standard (test)|gold standard test]] for amyloidosis. Particular stains can determine the subtype of amyloidosis. | ||
* [[Kidney]] is affected to a greater extent compared to other [[organs]]. The 24-hour urine collection with the assessment of urinary [[protein]] may be useful and in the case of [[renal]] involvement, a kidney biopsy is required. | * [[Kidney]] is affected to a greater extent compared to other [[organs]]. The 24-hour urine collection with the assessment of urinary [[protein]] may be useful and in the case of [[renal]] involvement, a kidney biopsy is required. | ||
* Staining the tissue sample with [[antibodies]] that are specific for AA amyloidosis will confirm the final [[diagnosis]]. | * Staining the tissue sample with [[antibodies]] that are specific for AA amyloidosis will confirm the final [[diagnosis]]. | ||
*'''Organ-specific labs''': If a particular [[Organ (biology)|organ]] is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, [[liver function tests]] (such as [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[Bilirubin|total bilirubin]], and [[alkaline phosphatase]]) should be measured. | *'''Organ-specific labs''': If a particular [[Organ (biology)|organ]] is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, [[liver function tests]] (such as [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[Bilirubin|total bilirubin]], and [[alkaline phosphatase]]) should be measured.<ref name="GertzComenzo2005">{{cite journal|last1=Gertz|first1=Morie A.|last2=Comenzo|first2=Ray|last3=Falk|first3=Rodney H.|last4=Fermand|first4=Jean Paul|last5=Hazenberg|first5=Bouke P.|last6=Hawkins|first6=Philip N.|last7=Merlini|first7=Giampaolo|last8=Moreau|first8=Philippe|last9=Ronco|first9=Pierre|last10=Sanchorawala|first10=Vaishali|last11=Sezer|first11=Orhan|last12=Solomon|first12=Alan|last13=Grateau|first13=Giles|title=Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): A consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis|journal=American Journal of Hematology|volume=79|issue=4|year=2005|pages=319–328|issn=0361-8609|doi=10.1002/ajh.20381}}</ref> | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
* Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well. | * Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well.<ref name="Real de AsuaGalvan2014">{{cite journal|last1=Real de Asua|first1=Diego|last2=Galvan|first2=Jose Maria|last3=Filigghedu|first3=Maria Teresa|last4=Trujillo|first4=Davinia|last5=Costa|first5=Ramon|last6=Cadinanos|first6=Julen|title=Systemic AA amyloidosis: epidemiology, diagnosis, and management|journal=Clinical Epidemiology|year=2014|pages=369|issn=1179-1349|doi=10.2147/CLEP.S39981}}</ref> | ||
{| | {| | ||
! colspan="2" style="background:#DCDCDC;" align="center" + |The table below adopted from Clinical Epidemiology Journal | ! colspan="2" style="background:#DCDCDC;" align="center" + |The table below adopted from Clinical Epidemiology Journal | ||
| Line 21: | Line 22: | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnostic Criteria | | colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Diagnostic Criteria''' | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: left;" |Organ | | style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Organ''' | ||
| style="background: #DCDCDC; padding: 5px; text-align: left;" |Criteria | | style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Criteria''' | ||
|- | |- | ||
|Kidney | |Kidney | ||
| Line 45: | Line 46: | ||
* | * | ||
| | | | ||
* Alkaline phosphatase> 1.5 upper | * Alkaline phosphatase> 1.5 upper limits of normal | ||
* Hepatomegaly >15 cm | * Hepatomegaly >15 cm | ||
* Absence of heart failure | * Absence of heart failure | ||
Revision as of 21:38, 29 October 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Sahar Memar Montazerin, M.D.[2]
Overview
The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Urinary protein measurement followed by renal biopsy is the gold standard of the diagnosis.
Diagnostic Study of Choice
- Since AA amyloidosis is a condition that occurred due to another illness, the diagnostic study of choice varies according to the primary disorder.[1]
- However, the amyloidosis itself should be confirmed through histologic examination of the affected organs.
- A tissue biopsy of the affected organ is the gold standard test for amyloidosis. Particular stains can determine the subtype of amyloidosis.
- Kidney is affected to a greater extent compared to other organs. The 24-hour urine collection with the assessment of urinary protein may be useful and in the case of renal involvement, a kidney biopsy is required.
- Staining the tissue sample with antibodies that are specific for AA amyloidosis will confirm the final diagnosis.
- Organ-specific labs: If a particular organ is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, liver function tests (such as AST, ALT, total bilirubin, and alkaline phosphatase) should be measured.[2]
Diagnostic Criteria
- Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well.[3]
| The table below adopted from Clinical Epidemiology Journal |
|---|
| Diagnostic Criteria | |
| Organ | Criteria |
| Kidney
|
|
| Heart
|
|
| Liver
|
|
| Nerve
|
|
| Gastrointestinal tract
|
|
| Lung |
|
| Skin and soft tissue |
|
- ↑ Lachmann, Helen J.; Goodman, Hugh J.B.; Gilbertson, Janet A.; Gallimore, J. Ruth; Sabin, Caroline A.; Gillmore, Julian D.; Hawkins, Philip N. (2007). "Natural History and Outcome in Systemic AA Amyloidosis". New England Journal of Medicine. 356 (23): 2361–2371. doi:10.1056/NEJMoa070265. ISSN 0028-4793.
- ↑ Gertz, Morie A.; Comenzo, Ray; Falk, Rodney H.; Fermand, Jean Paul; Hazenberg, Bouke P.; Hawkins, Philip N.; Merlini, Giampaolo; Moreau, Philippe; Ronco, Pierre; Sanchorawala, Vaishali; Sezer, Orhan; Solomon, Alan; Grateau, Giles (2005). "Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): A consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis". American Journal of Hematology. 79 (4): 319–328. doi:10.1002/ajh.20381. ISSN 0361-8609.
- ↑ Real de Asua, Diego; Galvan, Jose Maria; Filigghedu, Maria Teresa; Trujillo, Davinia; Costa, Ramon; Cadinanos, Julen (2014). "Systemic AA amyloidosis: epidemiology, diagnosis, and management". Clinical Epidemiology: 369. doi:10.2147/CLEP.S39981. ISSN 1179-1349.