Dr. Wong on the Difficulty of Diagnosing Patients With AL Amyloidosis

Sandy Wong, MD, assistant professor, University of California, San Francisco School of Medicine, discusses the presentation of AL amyloidosis in patients.

Treating amyloidosis is only one of the difficulties of the disease. The other difficulty lies in diagnosing the disease which is known to cause a unique pattern of organ involvement in every patient and mimic other common conditions. In AL amyloidosis, around 60-70% of patients have cardiac and/or renal involvement. When it affects the heart, the disease causes an infiltrative cardiomyopathy which is typically a symptom of heart failure.

Swelling in the legs and shortness of breath, especially from exertion, are other common symptoms. If it affects the kidneys, it can cause decreases in the filtration rate of the kidneys and can also cause spillage of protein into the urine. Amyloid can also deposit in other organs in the body such as the gut, the liver, and the peripheral nerves.

These symptoms are commonly linked to other causes because AL amyloidosis is not a common disease and therefore not typically diagnosed until late in its course.