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©2013 UpToDate ® Print Email Light micrograph showing glomerular amyloidosis Light micrograph of glomerular amyloidosis shows nodular amorphous material (arrows) extending from the mesangium into the capillary loops and narrowing or closing the capillary lumens. Amyloid deposits are pale when H&E stain is applied and do not stain with periodic acid-Schiff (PAS) or with methenamine silver stain. They are usually more amorphous than those of diabetic nephropathy, which are positive on PAS and silver stain. The diagnosis of renal amyloidosis relies upon the demonstration of amyloid fibrils by electron microscopy or green birefringence with Congo red staining. Courtesy of Helmut Rennke, MD. Normal glomerulus Light micrograph of a normal glomerulus. There are only 1 or 2 cells per capillary tuft, the capillary lumens are open, the thickness of the glomerular capillary wall (long arrow) is similar to that of the tubular basement membranes (short arrow), and the mesangial cells and mesangial matrix are located in the central or stalk regions of the tuft (arrows). Courtesy of Helmut G Rennke, MD.

©2013 UpToDate ® Print Email Light micrograph showing glomerular amyloidosis Light micrograph of glomerular amyloidosis shows nodular amorphous material (arrows) extending from the mesangium into the capillary loops and narrowing or closing the capillary lumens. Amyloid deposits are pale when H&E stain is applied and do not stain with periodic acid-Schiff (PAS) or with methenamine silver stain. They are usually more amorphous than those of diabetic nephropathy, which are positive on PAS and silver stain. The diagnosis of renal amyloidosis relies upon the demonstration of amyloid fibrils by electron microscopy or green birefringence with Congo red staining. Courtesy of Helmut Rennke, MD. Normal glomerulus Light micrograph of a normal glomerulus. There are only 1 or 2 cells per capillary tuft, the capillary lumens are open, the thickness of the glomerular capillary wall (long arrow) is similar to that of the tubular basement membranes (short arrow), and the mesangial cells and mesangial matrix are located in the central or stalk regions of the tuft (arrows). Courtesy of Helmut G Rennke, MD. Congo red stain in amyloidosis Congo red stain viewed under polarized light of a renal biopsy from a patient with renal amyloidosis. Green birefringence (white arrows) of interstitial amyloid deposits can be seen. Courtesy of Helmut Rennke, MD. Electron micrograph showing renal amyloidosis Electron micrograph showing expansion of the mesangium by amyloid fibrils, which can measure 7 to 12 nanometers in diameter. The fibrillar appearance is best appreciated at the arrow. These fibrils are smaller than those seen in fibrillary and immunotactoid glomerulonephritis. Courtesy of Helmut Rennke, MD. Electron micrograph of a normal glomerulus Electron micrograph of a normal glomerular capillary loop showing the fenestrated endothelial cell (Endo), the glomerular basement membrane (GBM), and the epithelial cells with its interdigitating foot processes (arrow). The GBM is thin, and no electron dense deposits are present. Two normal platelets are seen in the capillary lumen. Courtesy of Helmut Rennke, MD.

©2013 UpToDate ® Print Email Light micrograph showing glomerular amyloidosis Light micrograph of glomerular amyloidosis shows nodular amorphous material (arrows) extending from the mesangium into the capillary loops and narrowing or closing the capillary lumens. Amyloid deposits are pale when H&E stain is applied and do not stain with periodic acid-Schiff (PAS) or with methenamine silver stain. They are usually more amorphous than those of diabetic nephropathy, which are positive on PAS and silver stain. The diagnosis of renal amyloidosis relies upon the demonstration of amyloid fibrils by electron microscopy or green birefringence with Congo red staining. Courtesy of Helmut Rennke, MD. Normal glomerulus Light micrograph of a normal glomerulus. There are only 1 or 2 cells per capillary tuft, the capillary lumens are open, the thickness of the glomerular capillary wall (long arrow) is similar to that of the tubular basement membranes (short arrow), and the mesangial cells and mesangial matrix are located in the central or stalk regions of the tuft (arrows). Courtesy of Helmut G Rennke, MD. Congo red stain in amyloidosis Congo red stain viewed under polarized light of a renal biopsy from a patient with renal amyloidosis. Green birefringence (white arrows) of interstitial amyloid deposits can be seen. Courtesy of Helmut Rennke, MD. Electron micrograph showing renal amyloidosis Electron micrograph showing expansion of the mesangium by amyloid fibrils, which can measure 7 to 12 nanometers in diameter. The fibrillar appearance is best appreciated at the arrow. These fibrils are smaller than those seen in fibrillary and immunotactoid glomerulonephritis. Courtesy of Helmut Rennke, MD. Electron micrograph of a normal glomerulus Electron micrograph of a normal glomerular capillary loop showing the fenestrated endothelial cell (Endo), the glomerular basement membrane (GBM), and the epithelial cells with its interdigitating foot processes (arrow). The GBM is thin, and no electron dense deposits are present. Two normal platelets are seen in the capillary lumen. Courtesy of Helmut Rennke, MD. Immunofluorescence microscopy revealing secondary amyloidosis Immunofluorescence microscopy in secondary amyloidosis using an anti-AA antiserum. Markedly positive staining is present in the glomeruli. Although not shown, there is also substantial amyloid deposition in the tubules. Courtesy of Helmut Rennke, MD.