The initial treatment of this patient involves fluid and salt restriction, and diuretics to reduce
the oedema. He should be anticoagulated to reduce the risk of deep vein thrombosis or pul-
monary embolus. His hyperlipidaemia should be treated with a statin. Definitive treatment
is by chemotherapy supervised by the haematologists to suppress the amyloidogenic plasma
cell clone. In younger patients, bone marrow transplantation may be considered. Patients
with nephrotic syndrome secondary to amyloidosis usually progress to end-stage renal fail-
ure relatively quickly. Death is most commonly due to cardiac involvement.
Figure 22.1Serum amyloid P scan showing uptake
predominantly in the spleen.- Bilateral oedema may be due to cardiac, liver or renal disease.
- All patients presenting with new-onset oedema should have a urinalysis.
- Patients with nephrotic syndrome are at increased risk of pulmonary embolism.