AL type renal amyloidosis with cardiac involvement: A case report and literature review

Systemic amyloidosis refers to a spectrum of diseases characterized by extracellular deposition of amyloids, with commonrenal involvement; however, simultaneous involvement of cardiac amyloidosis remains rare. The purpose of this report was to enhance the understanding of the diagnosis and treatment of light chain (AL)-type renal amyloidosis with cardiovascular involvement, reduce misdiagnosis and missed diagnosis, and enable timely and effective treatment for such patients.

A 74-year-old male patient was admitted to our hospital because of recurrent edema for over 1 year and aggravated recurrence with decreased urine for 1 month. Pathological examination of the renal biopsy specimen showed homogeneous nonstructural material deposition in the glomerular mesangial area.

This patient was diagnosed with lightchain (AL)-type renal amyloidosis with cardiac involvement.

Treatment with daretomumab (DARA) 800mg plus cyclophosphamide 0.4g, bortezomib 1.6mg and dexamethasone 20mg (D-VCD regimen). Interventions, such as intermittent diuresis, anticoagulation, and electrolyte imbalance, were administered.

After 2 courses of chemotherapy, edema was relieved, urine protein was reduced, and symptoms improved. Chemotherapy was continued in accordance with the regimen described above.

Due to the rarity and nonspecific symptoms, missed diagnosis and misdiagnosis of AL-type renal amyloidosis remain common. Among patients with a confirmed diagnosis, in addition to considering the pathological changes in the kidney, consideration of the presence of amyloidosis in other organs, such as cardiac involvement, is also necessary.