Question:easy

A patient with long-standing rheumatoid arthritis develops nephrotic-range proteinuria. Renal biopsy with Congo red stain shows apple-green birefringence under polarised light. Which type of amyloid protein is most likely deposited?

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Acute-phase reactant SAA is the precursor in reactive amyloidosis.
Updated On: Jun 25, 2026
  • AA (serum amyloid A-derived) amyloid
  • AL (immunoglobulin light chain) amyloid
  • Abeta₂-microglobulin amyloid
  • ATTR (transthyretin) amyloid
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The Correct Option is A

Solution and Explanation

Trace the biochemistry. Sustained inflammation drives hepatic synthesis of the acute-phase protein serum amyloid A ($SAA$), a high-density-lipoprotein-associated apolipoprotein. When inflammation is chronic and unresolved, $SAA$ is cleaved and its insoluble fragments aggregate into beta-pleated fibrils - this deposited material is termed $AA$ amyloid, and the resulting disease is reactive (secondary) systemic amyloidosis.

Rheumatoid arthritis is the prototypical Western cause; worldwide, chronic infections such as tuberculosis and osteomyelitis contribute heavily. The kidney is the dominant target organ, explaining the heavy proteinuria.

The alternatives map to different precursors: light-chain $AL$ to plasma-cell dyscrasias, $A\beta_2$-microglobulin to chronic dialysis, and transthyretin $ATTR$ to senile/hereditary cardiac amyloidosis.

\[\boxed{\text{Chronic inflammation} \rightarrow SAA \rightarrow AA\ \text{amyloid}}\]
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