What is the role of lab tests in the workup of AA (inflammatory) amyloidosis?

Updated: Aug 11, 2020
  • Author: Richa Dhawan, MD, CCD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

No specific tests for AA amyloidosis exist. While the serum amyloid A (SAA) precursor is usually elevated, prolonged elevation does not necessarily indicate tissue deposition because many patients with inflammatory disease have very high levels of SAA without developing amyloidosis. Serum immunoglobulins should be evaluated because the presence of a monoclonal serum or urine protein suggests AL amyloidosis as a more likely diagnosis. Patients with AA amyloidosis tend to show polyclonal hypergammaglobulinemia, reflecting their underlying inflammatory condition.

Evaluate the parameters of renal function to monitor the course of the nephrotic syndrome or renal failure. Occasionally, patients show renal tubular acidosis as an early manifestation of renal involvement.  Deterioration of a patient with the nephrotic syndrome may indicate progression of the amyloid renal disease, but consider the possibility of renal vein thrombosis because this complication can be observed in nephrotic syndrome due to any cause.

A serum creatinine level greater than 2 mg/dL and/or a serum albumin level less than 2.5 g/dL have been associated with diminished survival rates, including renal survival.


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