Abstract: SA-PO105
Chest Pain, Diarrhea, AKI, and Anemia: Uniting Them
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Sian, Jaspreet, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Levea, Swee-Ling, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Hendricks, Allen, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Introduction
Amyloidosis is a systemic disease with multiorgan involvement affecting 4000 Americans a year. Diagnosis is often delayed and overlooked. In this case a patient presents with many symptoms and a renal biopsy unites them.
Case Description
69 year old male with pancreas and kidney transplant presents for chronic diarrhea for several weeks, chest pain, acute kidney injury (AKI) and anemia. GI panel positive for sapovirus. Cr improves with IV fluids but with ongoing diarrhea colonoscopy is done showing edematous colon. Chest pain persists and catheterization showed 60% proximal stenosis of the LAD and 40% left circumflex and RCA stenosis. He is discharged on aspirin.
One week later, he has a rash and AKI with a Cr of 13.3. UA has eosinophils and cholesterol emboli is diagnosed. Dialysis is initiated and patient transferred for renal biopsy which is performed. The glomeruli had diffuse mesangial expansion by eosinophilic, amorphous, acellular material, walls of arteries and arterioles were expanded by the same material (Figure 1A). A Congo red stain was positive in glomeruli, arteries, and arterioles (Figure 1B). This is consistent with AL amyloidosis, lambda light chain type. Bone marrow biopsy shows plasma cell neoplasm involving 40 to 50% of bone marrow. Cardiac MRI is consistent with amyloid. Colon biopsy positive for amyloid. Patient was started on chemotherapy but expired.
Discussion
Amyloidosis is deposition of insoluble amyloid proteins that form B-pleated sheets. AL amyloid is composed of monoclonal gamma or kappa light chains. Light chains deposit in many organs and can present as anasarca, GI bleeding, dysphagia, weight loss, portal hypertension, diarrhea, chest pain, arrythmia and macroglossia. Diagnosis requires a biopsy of a fat pad or bone marrow and undergo evaluation for extent of organ involvement with cardiac MRI, coloscopy and skin biopsy. In this patient, due to his history of transplants, his work up was focused on infectious etiology for diarrhea. With the rarity of this disease, many are diagnosed late or not at all, which is why it is important to consider a unifying diagnosis for what may appear to be independent disease processes.