title: Medullary amyloidosis associated with apolipoprotein A-IV deposition.
abstract: Amyloidosis is caused by extracellular deposition of proteins in an insoluble manner within tissues. In hereditary forms of amyloidosis, transthyretin, fibrinogen A-α, lysozyme, gelsolin, apolipoprotein A-I, and A-II accumulate in the tissue plaques. Here we describe a 52-year-old man with no family history of renal disease who presented with increased urinary frequency, gradual loss of renal function but no significant proteinuria. Renal biopsy found large amounts of amyloid restricted to the medulla with no involvement of glomeruli or vessels. Immunohistochemical analysis for transthyretin or serum amyloid A and tests for an underlying monoclonal gammopathy were negative. Although initially suspected to be amyloid light chain amyloidosis, laser microdissection and mass spectrometry showed that the amyloid was composed of large amounts of apolipoprotein A-IV. This was based on mass spectrometry studies that showed 100, 96, and 73 spectra in three microdissected samples that matched to apolipoprotein A-IV with 100% probability. DNA analyses detected three sequence variants representing common polymorphisms of the apolipoprotein A-IV gene. Thus, in this case, apolipoprotein A-IV deposition and renal involvement appear to be restricted to the medulla. A high degree of suspicion is required for the diagnosis of apolipoprotein A-IV amyloidosis as it may be missed if a renal biopsy consists only of cortex.
authors: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA. sethi.sanjeev@mayo.edu
authors: Sanjeev
authors: S
authors: Sethi
authors: Jason D
authors: JD
authors: Theis
authors: Shirley M
authors: SM
authors: Shiller
authors: Cynthia C
authors: CC
authors: Nast
authors: David
authors: D
authors: Harrison
authors: Helmut G
authors: HG
authors: Rennke
authors: Julie A
authors: JA
authors: Vrana
authors: Ahmet
authors: A
authors: Dogan
mesh_terms: D000686:Amyloidosis / Q000378:metabolism*; D001054:Apolipoproteins A / Q000378:metabolism*; D001706:Biopsy; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism* / Q000473:pathology*; D007679:Kidney Medulla / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged
chemical_list: D001054:Apolipoproteins A; C022205:apolipoprotein A-IV