Primary amyloidosis differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Primary (AL) Amyloidosis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Primary (AL) Amyloidosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Monoclonal plasma cell proliferation | *[[Monoclonal]] [[plasma cell]] proliferation | ||
* Extracellular amyloid fibril deposition | * Extracellular [[amyloid]] fibril deposition | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Anasarca | *[[Anasarca]] | ||
* Bleeding tendency | *[[Bleeding tendency]] | ||
* Swelling of lower limbs | * Swelling of [[lower limbs]] | ||
* Frothy urine | * Frothy [[urine]] | ||
* Chest pain | *[[Chest pain]] | ||
* Numbness or tingling | *[[Numbness]] or [[tingling]] | ||
* Early satiety | *[[Early satiety]] | ||
* Joint pains | *[[Joint pains]] | ||
* Enlarged tongue | *[[Macroglossia|Enlarged tongue]] | ||
* Taste loss | *[[Taste loss]] | ||
* Hoarseness of voice | *[[Hoarseness|Hoarseness of voice]] | ||
* Hair loss <br /> | *[[Alopecia|Hair loss <br />]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Increased erythrocyte sedimentation rate (ESR) | * Increased [[erythrocyte sedimentation rate]] ([[ESR]]) | ||
* Increased alanine aminotrasnferase (ALT) and aspartate aminotrasnferase (AST) | * Increased [[Alanine aminotransferase|alanine aminotrasnferase]] ([[Alanine transaminase|ALT]]) and [[Aspartate aminotransferase|aspartate aminotrasnferase]] ([[Aspartate transaminase|AST]]) | ||
* Increased cardiac troponins | * Increased [[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponins]] | ||
* Increased brain natriuretic peptide (BNP) | * Increased [[brain natriuretic peptide]] ([[BNP]]) | ||
* Increased blood urea nitrogen (BUN) and creatinine | * Increased [[blood urea nitrogen]] ([[BUN]]) and [[creatinine]] | ||
* Proteinuria | *[[Proteinuria]] | ||
* Urinary hyaline and fatty casts | * Urinary [[Hyaline cast|hyaline]] and fatty casts | ||
*Hypercholesterolemia | *[[Hypercholesterolemia]] | ||
* | * | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Biopsy: | * Biopsy: | ||
** Diffuse glomerular deposition of amorphous hyaline material (nodular pattern - 8 to15 nm in diameter), in mesangium (weakly staining with periodic acid-Schiff (PAS) | ** Diffuse glomerular deposition of amorphous [[hyaline]] material (nodular pattern - 8 to15 nm in diameter), in [[mesangium]] (weakly staining with [[Periodic acid-Schiff stain|periodic acid-Schiff]] ([[Periodic acid-Schiff stain|PAS]]) | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Melphalan-prednisone/dexamethasone | *[[Melphalan]]-[[prednisone]]/[[dexamethasone]] | ||
* Dexamethasone plus Cyclophosphamide-thalidomide | *[[Dexamethasone]] plus [[Cyclophosphamide]]-[[thalidomide]] | ||
* Stem cell transplantation | *[[Stem cell transplantation]] | ||
*Kidney | *[[Kidney transplantation]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Diabetic Nephropathy | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Diabetic nephropathy|Diabetic Nephropathy]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Hyperfiltration | * Hyperfiltration | ||
* Constriction of efferent arteriole | * Constriction of [[efferent arteriole]] | ||
* Microalbuminuria | *[[Microalbuminuria]] | ||
* Mesangial proliferation | *[[Mesangial cell|Mesangial]] proliferation | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Nocturia | *[[Nocturia]] | ||
* Fatigue | *[[Fatigue]] | ||
* Pruritis | *[[Pruritis]] | ||
* Peripheral edema | *[[Peripheral edema]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Hyperglycemia (random plasma glucose ≥200 mg/dL) | *[[Hyperglycemia]] (random plasma glucose ≥200 mg/dL) | ||
* Proteinuria | *[[Proteinuria]] | ||
* Glucosuria | *[[Glucosuria]] | ||
* HbA1C ≥6.5% (48 mmol/mol). <br /> | *[[Glycosylated hemoglobin|HbA1C]] ≥6.5% (48 mmol/mol). <br /> | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Biopsy: | * Biopsy: | ||
** PAS positive Kimmelstiel-Wilson nodules | **[[Periodic acid-Schiff stain|PAS]] positive [[Kimmelstiel-Wilson syndrome|Kimmelstiel-Wilson nodules]] | ||
**Glomerulosclerosis | **[[Glomerulosclerosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* ACE inhibitors | *[[ACE inhibitor|ACE inhibitors]] | ||
* Angiotensin receptor blockers | *[[Angiotensin receptor blockers]] | ||
* Glycemic control | *[[Glycemic]] control | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Minimal Change Disease | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Minimal change disease|Minimal Change Disease]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Upper respiratory tract infection | *[[Upper respiratory tract infection]] | ||
* Allergy to bee sting | *[[Allergy]] to bee sting | ||
* NSAID | *[[Non-steroidal anti-inflammatory drug|NSAID]] | ||
* Gold | *[[Gold]] | ||
* Penicillamine | *[[Penicillamine]] | ||
* Ampicillin | *[[Ampicillin]] | ||
* Mercury | *[[Mercury (element)|Mercury]] | ||
* Hodgkin's and non-Hodgkin's lymphoma | *[[Hodgkin's lymphoma|Hodgkin's]] and [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Peripheral edema | *[[Peripheral edema]] | ||
* Hypertension | *[[Hypertension]] | ||
* Peripheral edema | *[[Peripheral edema]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Proteinuria | *[[Proteinuria]] | ||
* Hypertension | *[[Hypertension]] | ||
* Hyperlipidemia | *[[Hyperlipidemia]] | ||
* Hypoalbuminemia | *[[Hypoalbuminemia]] | ||
* Microscopic hematuria | *[[Microscopic hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Biopsy: | * Biopsy: | ||
** Fused podocytes/effacement | ** Fused [[podocytes]]/effacement | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Prednisone with taper | *[[Prednisone]] with taper | ||
* ACE inhibitors | *[[ACE inhibitor|ACE inhibitors]] | ||
* Angiotensin receptor blockers | *[[Angiotensin receptor blockers]] | ||
* Salt restriction | * Salt restriction | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Focal Segmental Glomerulosclerosis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Focal segmental glomerulosclerosis|Focal Segmental Glomerulosclerosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* HIV | *[[HIV]] | ||
* Parvovirus B19 | *[[Parvovirus B19]] | ||
* Cytomegalovirus | *[[Cytomegalovirus]] | ||
* Heroin | *[[Heroin]] | ||
* Interferon alpha | *[[Interferon alpha]] | ||
* Lithium | *[[Lithium]] | ||
* Pamidronate/aledronate | *[[Pamidronate]]/aledronate | ||
* Anabolic steroids | *[[Anabolic steroids]] | ||
* Diabetes mellitus | *[[Diabetes mellitus]] | ||
* Hypertension | *[[Hypertension]] | ||
* Obesity | *[[Obesity]] | ||
* Cyanotic congenital heart disease | *[[Congenital heart disease cyanotic|Cyanotic congenital heart disease]] | ||
* Sickle cell anemia | *[[Sickle cell anemia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Peripheral edema | *[[Peripheral edema]] | ||
* Hypertension | *[[Hypertension]] | ||
* Peripheral edema | *[[Peripheral edema]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Proteinuria | *[[Proteinuria]] | ||
* Hypertension | *[[Hypertension]] | ||
* Hyperlipidemia | *[[Hyperlipidemia]] | ||
* Hypoalbuminemia | *[[Hypoalbuminemia]] | ||
* Microscopic hematuria | *[[Microscopic hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Biopsy: | * Biopsy: | ||
** Podocyte foot process effacement | **[[Podocytes|Podocyte]] foot process effacement | ||
** Capillary lumen abolished by the segmental increase in matrix <br /> | **[[Capillary]] lumen abolished by the segmental increase in matrix <br /> | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Prednisone | *[[Prednisone]] | ||
* Calcineurin inhibitors (Cyclosporin, tacrolimus) | *[[Calcineurin inhibitor|Calcineurin inhibitors]] ([[Cyclosporine|Cyclosporin]], [[tacrolimus]]) | ||
* Rituximab | *[[Rituximab]] | ||
* Cyclophosphamide/chlorambucil | *[[Cyclophosphamide]]/[[chlorambucil]] | ||
* Mycophenolate motefil | *[[Mycophenolate|Mycophenolate motefil]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Fabry's Disease | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Fabry's disease|Fabry's Disease]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Deficient alpha galactosidase A | * Deficient alpha galactosidase A | ||
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* Kidney transplant | * Kidney transplant | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Membranous Glomerulonephritis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Membranous glomerulonephritis|Membranous Glomerulonephritis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Hepatitis B and C | * Hepatitis B and C | ||
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|- | |- | ||
| rowspan="6" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Polyneuropathy''''' | | rowspan="6" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Polyneuropathy''''' | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''POEMS syndrome (Demyelinating)''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[POEMS syndrome]] (Demyelinating)''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Monoclonal]] [[plasma cell]] proliferation | *[[Monoclonal]] [[plasma cell]] proliferation |
Revision as of 19:25, 30 October 2019
Primary amyloidosis Microchapters |
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Primary amyloidosis differential diagnosis On the Web |
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Risk calculators and risk factors for Primary amyloidosis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
- Differentiating Primary amyloidosis from Other Diseases
Organ System Involvement | Differential Diagnosis | Causes | Clinical Features | Laboratory Findings | Gold Standard Test | Therapy |
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Nephrotic Syndrome and Real Failure | Primary (AL) Amyloidosis |
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Diabetic Nephropathy |
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Minimal Change Disease |
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Focal Segmental Glomerulosclerosis | ||||||
Fabry's Disease |
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Light Chain Deposition Disease |
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Membranous Glomerulonephritis |
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Fibrillary-Immunotactoid Glomerulopathy |
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Organ System Involvement | Differential Diagnosis | Causes | Clinical Features | Laboratory Findings | Gold Standard Test | Therapy |
Polyneuropathy | POEMS syndrome (Demyelinating) |
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Metabolic Syndrome (Axonal pathology) |
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Vitamin Deficiencies (Axonal Pathology) |
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Guillain-Barre Syndrome (Demyelinating) |
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Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (Mixed axonal and demyelinatiing) |
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Multifocal Motor Neuropathy |
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Organ System Involvement | Differential Diagnosis | Causes | Features | Laboratory Findings | Gold Standard Test | Therapy |
Organomegaly (Hepatosplenomegaly and Lymphadenopathy) | Malaria |
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Kala-azar |
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Infective Hepatitis |
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Chronic Myelogenous Leukemia (CML) |
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Lymphoma |
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Primary (AL) Amyloidosis |
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Gaucher's Disease |
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Organ System Involvement | Differential Diagnosis | Causes | Features | Laboratory Findings | Gold Standard Test | Therapy |
Cardiac Failure | Cardiac amyloidosis (AL and ATTRwt) |
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Hypertrophic obstructive cardiomyopathy |
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Alcoholic cardiomyopathy |
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ST-elevation myocardial infarction |
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Pericarditis |
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Non-ST-segment elevation myocardial infarction |
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Organ System Involvement | Differential Diagnosis | Causes | Features | Laboratory Findings | Gold Standard Test | Therapy |
Plasma Cell Dyscrasias | Multiple myeloma |
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AND
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Monoclonal gammopathy of undetermined significance (MGUS) |
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AND
AND
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Asymptomatic Plasma Cell Myeloma |
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OR
AND/OR
AND
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Plasmacytoma |
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Skin Changes | Scurvy |
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