Apolipoprotein AII amyloidosis
Synonyms and keywords:

# Overview

# Historical Perspective
- In 1639, Nicolaus Fontanus autopsied a young man who had ascites, jaundice, liver abscess, and splenomegaly and his report has been the first description of amyloidosis.
- In 1854, Rudolph Virchow introduced the term "amyloid" as a macroscopic abnormality in some tissues.
- In 1867, Weber reported the first case of amyloidosis associated with multiple myeloma.
- In 1922, Bennhold introduced Congo Red staining of amyloid that remains the gold standard for diagnosis.
- In 1959, Cohen and Calkins used ultrathin sections of amyloidotic tissues and assessed by electron microscopy, explained the presence of non-branching fibrils with indeterminate length and variable width.

# Classification
Apolipoprotein AII amyloidosis is one of the subtypes of familial amyloidosis. Familiar amyloidosis may be classified according to the type of mutant protein into 7 subtypes:
- Transthyretin (TTR)
- Apolipoprotein AI
- Apolipoprotein AII
- Fibrinogen Aa
- Lysozyme
- Gelsolin
- Cystatin C

# Pathophysiology

## Pathogenesis
- It is understood that amyloidosis is the result of deposition of Amyloid.
- Amyloid is an abnormal insoluble extracellular protein which may cause organic dysfunction and a wide variety of clinical syndromes.
- These abnormal amyloids are derived from misfolding and aggregation of normally soluble proteins.
- Amyloid depositions also have glycosaminoglycans and serum amyloid P component (SAP) which alter the propensity for amyloid formation.
- Amyloid deposition can disrupt tissue structure of involved organ and consequently leads to organ failure.
- Genetic mutations in Apolipoprotein AII gene may lead to misfolding protein product.

## Genetics
- 3 different mutations in the stop codon for the ApoAII gene including stop78Gly, stop78Ser, and stop78Arg has been found to be associated with amyloidosis.
- These mutations lead to an extra 21-amino acid at the carboxyl terminal end of the protein.

# Causes
Common cause of Apolipoprotein AII amyloidosis is genetic mutation.

# Differentiating ((Page name)) from Other Diseases
 must be differentiated from other diseases that cause , , and , such as , , and .
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 must be differentiated from , , and .

# Epidemiology and Demographics
- The incidence of amyloidosis is approximately 1.2 per 100,000 individuals per year worldwide.
- The mortality rate of systemic amyloidosis is approximately 100 per 100,000 deaths in developed countries.
- In apolipoprotein AII amyloidosis, the mean age of presentation is early adulthood.
- Hereditary amyloidosis subtypes include a substitution of an amino acid that is detected in approximately 4% of the african american population.
- Men are more commonly affected by amyloidosis than women.

# Risk Factors
Common risk factors in the development of apolipoprotein AII amyloidosis include:
- Older age
- Male gender
- African american race
- Positive family history

# Screening
There is insufficient evidence to recommend routine screening for apolipoprotein AII amyloidosis.

# Natural History, Complications, and Prognosis
If left untreated, % of patients with  may progress to develop , , and .
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Common complications of  include , , and .
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with  is approximately %.

# Diagnosis

## Diagnostic Study of Choice
- Tissue biopsy with Congo red stain is the gold standard test for the diagnosis of apolipoprotein AII amyloidosis.
- Biopsy tissue may be taken from an affected organ like kidney, or from subcutaneous fat or rectal mucosa.
- The rectal mucosa biopsy is more sensitive for apolipoprotein AII amyloidosis.
- Biopsy of the affected organ is recommended for patients with limited organ involvement.
- Biopsy from unaffected organs is more sensitive in patients with multi-organ involvement.
- The following finding on performing tissue biopsy is confirmatory for familial amyloidosis:
Apple green birefringence of the tissue sample under polarized light with Congo red stain.
- Apple green birefringence of the tissue sample under polarized light with Congo red stain.
- There are no established criteria for the diagnosis of familial amyloidosis.

## History and Symptoms
The majority of patients with  are asymptomatic.
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The hallmark of  is . A positive history of  and  is suggestive of . The most common symptoms of  include , , and . Common symptoms of  include , , and . Less common symptoms of  include , , and .

## Physical Examination
Patients with  usually appear . Physical examination of patients with  is usually remarkable for , , and .
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Common physical examination findings of  include , , and .
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The presence of  on physical examination is diagnostic of .
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The presence of  on physical examination is highly suggestive of .

## Laboratory Findings
An elevated/reduced concentration of serum/blood/urinary/CSF/other  is diagnostic of .
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Laboratory findings consistent with the diagnosis of  include , , and .
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 is usually normal among patients with .
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Some patients with  may have elevated/reduced concentration of , which is usually suggestive of .
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There are no diagnostic laboratory findings associated with .

## Electrocardiogram
There are no ECG findings associated with .
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An ECG may be helpful in the diagnosis of . Findings on an ECG suggestive of/diagnostic of  include , , and .

## X-ray
There are no x-ray findings associated with .
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An x-ray may be helpful in the diagnosis of . Findings on an x-ray suggestive of/diagnostic of  include , , and .
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There are no x-ray findings associated with . However, an x-ray may be helpful in the diagnosis of complications of , which include , , and .

## Echocardiography or Ultrasound
There are no echocardiography/ultrasound  findings associated with .
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Echocardiography/ultrasound  may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include , , and .
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There are no echocardiography/ultrasound  findings associated with . However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include , , and .

## CT scan
There are no CT scan findings associated with .
OR
 CT scan may be helpful in the diagnosis of . Findings on CT scan suggestive of/diagnostic of  include , , and .
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There are no CT scan findings associated with . However, a CT scan may be helpful in the diagnosis of complications of , which include , , and .

## MRI
There are no MRI findings associated with .
OR
 MRI may be helpful in the diagnosis of . Findings on MRI suggestive of/diagnostic of  include , , and .
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There are no MRI findings associated with . However, a MRI may be helpful in the diagnosis of complications of , which include , , and .

## Other Imaging Findings
There are no other imaging findings associated with .
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 may be helpful in the diagnosis of . Findings on an  suggestive of/diagnostic of  include , , and .

## Other Diagnostic Studies
There are no other diagnostic studies associated with .
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 may be helpful in the diagnosis of . Findings suggestive of/diagnostic of  include , , and .
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Other diagnostic studies for  include , which demonstrates , , and , and , which demonstrates , , and .

# Treatment

## Medical Therapy
There is no treatment for ; the mainstay of therapy is supportive care.
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Supportive therapy for  includes , , and .
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The majority of cases of  are self-limited and require only supportive care.
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 is a medical emergency and requires prompt treatment.
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The mainstay of treatment for  is .
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The optimal therapy for  depends on the stage at diagnosis.
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 is recommended among all patients who develop .
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Pharmacologic medical therapy is recommended among patients with , , and .
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Pharmacologic medical therapies for  include (either) , , and/or .
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Empiric therapy for  depends on  and .
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Patients with  are treated with , whereas patients with  are treated with .

## Surgery
Surgical intervention is not recommended for the management of .
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Surgery is not the first-line treatment option for patients with . Surgery is usually reserved for patients with either , , and 
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The mainstay of treatment for  is medical therapy. Surgery is usually reserved for patients with either , , and/or .
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The feasibility of surgery depends on the stage of  at diagnosis.
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Surgery is the mainstay of treatment for .

## Primary Prevention
There are no established measures for the primary prevention of .
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There are no available vaccines against .
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Effective measures for the primary prevention of  include , , and .
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 vaccine is recommended for  to prevent . Other primary prevention strategies include , , and .

## Secondary Prevention
There are no established measures for the secondary prevention of .
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Effective measures for the secondary prevention of  include , , and .