Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

112 Amyloidosis

tests

Basic Blood Tests:

■low protein and albumin

■elevated cholesterol/triglyceride

■hyperbilirubinemia

Basic Urine Tests:

■proteinuria

Specific Diagnostic Tests

■Serum/urine electrophoresis/immunoelectrophoresis (AL)

■24 hour urine protein > 0.5 g/d in >70% patients with AL or AA amy-

loid

■Imaging:

➣echocardiography: cardiomegaly, diastolic abnormalities,

increased wall thickness, restrictive cardiomyopathy

➣“speckled” pattern with increased echo signal

■Radiographs: bone lesions in myeloma

■CT: hepatomegaly, splenomegaly

Other Tests

■Biopsy: tissue required for diagnosis.

■biopsy site based on affected organs and suspected type

■Congo red-green birefringence under polarized light

■abdominal fat pad biopsy in systemic amyloidosis

■bone marrow biopsy

■rectal biopsy

■cardiac, renal, carpal tunnel, peripheral nerve biopsy may be

required

■Protein/gene analysis: transthyretin mutations

differential diagnosis

■multiple myeloma should be distinguished from AL

■other plasma cell abnormalities can have similar findings without

amyloid

management

What to Do First

■assess specific organ involvement

General Measures

■manage heart failure