**4. Conclusions**

*Amyloid Diseases*

**Figure 17.**

**Figure 18.**

*Serum electrophoresis, M-spike.*

*AL amyloidosis, spontaneous subcutaneous hemorrhages.*

**86**

**Figure 19.**

*Treatment results in 49 patients with AL amyloidosis, personal data [23].*

Clinical diagnosis of AA and AL systemic amyloidosis, most often affecting kidneys, is based on the presence of proteinuria or nephrotic syndrome and impaired kidney function in patients with extrarenal manifestations. Kidney biopsy is crucial for the diagnostics, and while Congo red staining with examination of Congopositive material in the polarized light is confirmative for amyloidosis as such, immunofluorescence and immunohistochemistry technics are helpful to distinguish AA and AL types. Differential diagnostics of AA and AL types guides the treatment strategies. In cases when neither AA nor AL amyloidosis are confirmed, one should consider rare types of amyloidosis, based on the presence of renal involvement— ALECT2, AapolA I, II and IV, AFib or ALys amyloidosis.

### **Acknowledgements**

Author thanks doctors Olga Vorobova, Ekaterina Stolyarevich, Vladimir Bedin, Mikhail Tavobilov, Evgeny Shutov, Eugene Nikitin, Marina Rybakova and Igor Miloserdov for their help in diagnostics and treatment of the patients.

#### **Conflict of interest**

Author declares no conflict of interests.

## **Author details**

Elena Zakharova City Clinical Hospital n.a. S.P. Botkin, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russian Federation

\*Address all correspondence to: helena.zakharova@gmail.com

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