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Recurrence of amyloidosis secondary to chronic infections in the renal allograft is highly unusual. We report the recurrence of amyloid in the graft within one year after transplantation in a patient with systemic AA amyloidosis secondary to tuberculosis. The diagnosis of tuberculosis was made in the immediate post-transplant period on the basis of good therapeutic response of fever and chest infiltrates to anti-tubercular chemotherapy.

Deranged coagulogram is a common problem, which a nephrologist faces before doing a renal biopsy. We describe a rare cause of coagulopathy in a patient with rapidly progressive renal failure due to acquired factor X deficiency caused by systemic light chain amyloidosis (AL). The patient had prolonged prothrombin and activated partial thromboplastin time, which got corrected on mixing with normal plasma, and factor X activity was markedly reduced at 5%. Rectal biopsy and immunofixation electrophoresis established the diagnosis of AL and the patient was started on bortezomib-based chemotherapy. Hence, appropriate coagulation work-up should be conducted in patients with renal dysfunction with prolonged coagulation times, as it can sometimes reveal the underlying diagnosis in situations where renal biopsy could not be done due to high risk of bleeding. [ABSTRACT FROM AUTHOR]