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A 64-year-old woman comes to her doctor™s office complaining that she feels œtired all the time and œbasically unwell. She began feeling this way about 4 months ago and she thinks that her symptoms are getting worse. Her husband agrees. Her medical history is significant for rheumatoid arthritis, which is controlled with celecoxib. She denies difficulty breathing, chest pain or palpitations, weight gain, mood alterations, and difficulty sleeping or eating. Her physical examination reveals a firm, somewhat rubbery abdominal fat pad. Her doctor orders basic labs, including a chemistry panel, which reveals a creatinine of 1.5 mg/dL. The physician follows with a fat-pad biopsy, which stains positively with Congo red. Which of the following abnormal proteins is likely causing this patient™s renal failure?
A. AA
B. AL
C. Kappa
D. Lambda
E. M
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it is secondary amyloidosiss AA
Sorry for changing answers
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it's actually good steady.....this time change was good.... :o)....here's the explanation for diff. btw A and B ans choices...
answer is A. This patient has amyloidosis. Amyloidosis is a condition in which a pathologic protein, amyloid, is laid down between cells of various tissues of the body”including the kidneys, liver, heart, and spleen. It is believed to be an autoimmune disease. The secondary type, or reactive type, is associated with chronic inflammatory conditions”most commonly rheumatoid arthritis, but also TB, osteomyelitis, and even skin-popping from heroin abuse. In the reactive amyloidosis, AA protein is laid down. AA is derived from the SAA protein, which is produced by the liver.
The primary form can be associated with multiple myeloma and B-cell lymphomas, and the AL form of the protein is deposited. AL protein is derived from immunoglobulin light chains, which are elaborated from plasma cells.
