Congo red positive glomeruli in a renal transplant
A 73-year-old man develops proteinuria in his kidney transplant. A biopsy shows strong congo red staining and randomly scattered fibrils on EM suggesting amyloidosis, but some of the fibrillary structures look larger and more organized than typical primary amyloidosis. A non-amyloid yet “congophilic” glomerulopathy that should be considered is Fibrillary GN. Is mass spec on the tissue always required as the next step in confirming and identifying the specific etiology of amyloid? Can the tissue be analyzed for DNAJB9? What other data do we need to make a diagnosis?
Summary provided by Roger Rodby, MD, FASN.
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