Secondary (AA) Amyloidosis with Development of Nephrotic Syndrome

A 25-year-old Caucasian female with a history of irritable bowel syndrome, presented to the emergency room with worsening upper bilateral abdominal pain and fatigue that began two days before arrival. The patient described having mild intermittent lower back pain and worsening bilateral edema of her ankles that began several months prior. Blood and urine specimens were tested, with results indicating the presence of systemic inflammation and nephrotic syndrome. The patient was admitted to the hospital for further testing and observation. An ultrasound of the kidneys was negative for renal calculus. A gallium scan indicated localization of leukocytes in the kidneys, liver and spleen. A CT urogram indicated renal damage and a SAP scan indicated amyloid deposits in the kidneys, liver and spleen. The patient was diagnosed with amyloidosis and nephrotic syndrome. Corticosteroids were prescribed and testing to determine the underlining cause of amyloidosis was initiated. ABBREVIATIONS: BUN - blood urea nitrogen, CBC - complete blood count, CRP - C-reactive protein, ECM - extracellular matrix, ESR - erythrocyte sedimentation rate, HLA - human leukocyte antigen, RBC - red blood cell, SAA - serum amyloid A, SAP - serum amyloid P, TNF - tumor necrosis factor, WBC - white blood cell