INTRODUCTION :

 Amyloidosis is a potentially life-threatening disorder.In developing countries like India tuberculosis is still the commonest underlying cause for renal amyloidosis. Other causes include rheumatoid arthritis, inflammatory bowel disease, dialysis etc. Amyloidosis can be easily diagnosed by congo red staining and other methods.

CASE :

 A 40 year old male presented with complaints of bilateral pedal oedema, abdominal distension, eye lid oedema ,breathlessness and cough with expectoration. Patient is a case of sputum positive pulmonary tuberculosis on category two ant tuberculosis therapy. Patient had hypoalbuminemia. Patients ECG and 2D ECHO was normal. Urine routine microscopy revealed albumin of 3+. 24 hour urine protein showed nephrotic range of protienuria. Serum lipid profile showed hyperlipidemia. Patient was labelled as nephrotic syndrome. Renal biopsy was done and histopathological examination showed characteristic picture of renal amyloidosis. : Patient was treated conservatively with salt restriction and ACE inhibitors.

DISCUSSION:

 In this context it is important to differentiate primary amyloidosis from secondary. This can be obtained by treating the deposit with potassium permanganate before Congo red staining so that the apple-green birefringence viewed in the polarized light is abolished in secondary when compared with primary amyloidosis. Amyloidosis secondary to TB presents after years of exposure to the tubercle bacilli with long-standing history of illness.

CONCLUSION :

 Renal amyloidosis should be suspected clinically in patients presenting with a triad of pedal oedema, proteinuria, and hypoproteinemia.