AL/AH/AHL |
Immunoglobulin light and/or heavy chain |
Deposition in glomeruli, vessels, and interstitium |
Sensitivity 85% and specificity 92% (Ref. 7171. Gonzalez Suarez ML, Zhang P, Nasr SH, Sathick IJ, Kittanamongkolchai W, Kurtin PJ, et al. The sensitivity and specificity of the routine kidney biopsy immunofluorescence panel are inferior to diagnosing renal immunoglobulin-derived amyloidosis by mass spectrometry. Kidney Int 2019; 96: 1005-1009, doi: 10.1016/j.kint.2019.05.027. https://doi.org/10.1016/j.kint.2019.05.0...
) for Ig |
AvailableDefinitive results are obtained in <60% of cases (Ref. 8080. Gillmore JD, Wechalekar A, Bird J, Cavenagh J, Hawkins S, Kazmi M, et al. Guidelines on the diagnosis and investigation of AL amyloidosis. Br J Haematol 2015; 168: 207-218, doi: 10.1111/bjh.13156. https://doi.org/10.1111/bjh.13156...
) |
>97% accuracy (Ref. 1717. Said SM, Sethi S, Valeri AM, Leung N, Cornell LD, Fidler ME, et al. Renal amyloidosis: origin and clinicopathologic correlations of 474 recent cases. Clin J Am Soc Nephrol 2013; 8: 1515-1523, doi: 10.2215/CJN.10491012. https://doi.org/10.2215/CJN.10491012...
) |
Not available |
AA |
Serum amyloid A |
Glomeruli always affected. Vascular and interstitium involvement are common |
Negative |
Available |
Equivocal cases |
Not available |
AFib |
Fibrinogen A α-chain |
Massive glomerular deposition. Medulla and vessels not involved |
Positive for fibrinogen |
AvailableNot definitive in ∼10% (Ref. 8181. Gillmore JD, Lachmann HJ, Rowczenio D, Gilbertson JA, Zeng CH, Liu ZH, et al. Diagnosis, pathogenesis, treatment, and prognosis of hereditary fibrinogen A alpha-chain amyloidosis. J Am Soc Nephrol 2009; 20: 444-451, doi: 10.1681/ASN.2008060614. https://doi.org/10.1681/ASN.2008060614...
) |
Inconclusive cases |
Available |
ALECT2 |
Leukocyte chemotactic factor 2 |
Deposition in glomeruli, vessels, and interstitium |
Negative |
AvailableHigh false-positive rate (Ref. 4040. Paueksakon P, Fogo AB, Sethi S. Leukocyte chemotactic factor 2 amyloidosis cannot be reliably diagnosed by immunohistochemical staining. Hum Pathol 2014; 45: 1445-1450, doi: 10.1016/j.humpath.2014.02.020. https://doi.org/10.1016/j.humpath.2014.0...
) |
LMD/MS to avoid inaccurate diagnosis(Ref. 4040. Paueksakon P, Fogo AB, Sethi S. Leukocyte chemotactic factor 2 amyloidosis cannot be reliably diagnosed by immunohistochemical staining. Hum Pathol 2014; 45: 1445-1450, doi: 10.1016/j.humpath.2014.02.020. https://doi.org/10.1016/j.humpath.2014.0...
) |
Not applicable |
ATTR |
Transthyretin |
Deposition in glomeruli, vessels, and interstitium |
Negative |
Available |
Inconclusive cases |
Available |
ALys |
Lysozyme |
Deposition in glomeruli, vessels, and interstitium |
Negative |
Available |
Inconclusive cases |
Available |
AApoAI |
Apolipoprotein AI |
Deposition in inner medulla. Interstitial nephritis |
Negative |
Available |
Inconclusive cases |
Available |
AApoAII |
Apolipoprotein AII |
Deposition in glomeruli and vessels |
Negative |
Available |
Inconclusive cases |
Available |
AApoAIV |
Apolipoprotein AIV |
Deposition restricted to renal medulla. Cortex is spared |
Negative |
Available |
Inconclusive cases |
Not applicable |
AApoCII |
Apolipoprotein CII |
Predominantly glomerular and medullary involvement. Minimal vessels/interstitial involvement |
Negative |
Not available |
Inconclusive cases |
Available |
AApoCIII |
Apolipoprotein CIII |
Deposition in glomeruli, vessels, and interstitium. Interstitial nephritis |
Negative |
Available |
Inconclusive cases |
Available |
AGel |
Gelsolin |
Restricted to glomeruli, spares vessels and interstitium |
Negative |
Available |
Inconclusive cases |
Available |