Step 2

Renal 3

A 65-year-old man presents to his primary care physician with complaints of progressive bilateral shoulder pain over the last two months. He denies any known trauma. He has a history of end-stage renal disease secondary to type 2 diabetes mellitus, hypertension, and secondary hyperparathyroidims. He receives hemodialysis three times per week. Medications include lisinopril, chlorthalidone, insulin, atorvastatin, calcitriol, and sevelamer, Physical examination is consistent with scapulohumeral arthritis, and shoulder X-ray is normal.

Which of the following is most likely to be present on biopsy of this patient’s rotator cuff?

  • A) Amyloid A fibrils
  • B) Amyloid light chain fibrils
  • C) Beta2-microglobulin fibrils
  • D) Diffuse calcifications
  • E) Transthyretin amyloid fibrils


Alexandra Conway


Dr. Ted O'Connell