title: Renal failure due to primary amyloidosis: a case report and literature review.
abstract: BACKGROUND
  Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review.
  
  
  METHODS
  A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m(2) and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment.
  
  
  CONCLUSIONS
  Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.
authors.affiliation: School of Medicine, University of Porto, "Francisco Gentil" Portuguese Institute of Oncology, Portugal. ramonmello@med.up.pt
authors.forename: Ramon Andrade Bezerra
authors.initials: RA
authors.lastname: de Mello
authors.forename: Dania Sofia Neiva
authors.initials: DS
authors.lastname: Marques Santos
authors.forename: Margarida Paula Rebelo Nunes
authors.initials: MP
authors.lastname: Freitas-Silva
authors.forename: Joaquim Aguiar
authors.initials: JA
authors.lastname: Andrade
mesh_terms: D000686:Amyloidosis / Q000150:complications*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology; D051437:Renal Insufficiency / Q000209:etiology*