Once a person has been diagnosed with amyloidosis then organ involvement with amyloid can be assumed if certain findings are present.
Patient selection: amyloidosis in tissue biopsy
Site
Findings
kidney
24-hour urine protein > 0.5 g per 24 hour, primarily albumin
heart
mean LV wall thickness > 12 mm in diastole; elevated NT-proBNP (> 332 ng/L) in the absence of renal failure or atrial fibrillation
liver
hepatomegaly in the absence of heart failure; serum alkaline phosphatase > 1.5 times ULN
nerve
peripheral neuropathy (symmetric, lower extremity, sensorimotor); autonomic (gastroparesis; pseudo colon obstruction; postural hypotension; erectile dysfunction; voiding dysfunction)
GI tract
symptoms with biopsy verification
lung
symptoms with biopsy verification; interstitial infiltrate on imaging studies
musculoskeletal
arthropathy; myopathy with muscle biopsy; pseudohypertrophy of muscle; carpal tunnel syndrome
vascular
claudication (presumed vascular amyloid)
skin
skin lesions
other
macroglossia, lymphadenopathy
It is often not necessary to take additional biopsies once the diagnosis has been established.
The findings assume that there is no other diagnosis that can explain the findings better.
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Specialty: Hematology Oncology
