Renal Amyloidosis: An Approach to Uniform Biopsy Reporting

Background: Renal amyloidosis results in progressive renal failure, and consistent biopsy reporting improves prognostic accuracy and permits interinstitutional comparisons. Objectives: This study aims to apply the histopathologic classification of Sen and Sarsik, calculate the Renal Amyloid Prognostic Score (RAPS), and correlate histological grade with clinical severity. Methods: We retrospectively analyzed 18 biopsy-proven cases of renal amyloidosis out of 1,008 native renal biopsies performed at IMS & SUM Hospital, Siksha 'O' Anusandhan (Deemed University), Bhubaneswar, Odisha, India, between January 2021 and January 2026. Glomerular amyloid pattern (GAP) classes I-VI, RAPS, and final histologic grade (0-3) were assigned. Clinical data included age, sex, 24-hour protein, urea, creatinine, and underlying diagnosis. Statistical analyses used independent t tests, Fisher’s exact test, and Spearman correlation. Results: The prevalence was 1.78%. The majority were primary amyloid light chain (AL) (12/18). Glomerular deposition was universal, with GAP class IV (15/18) predominating, associated with Grade 3. Grade 3 had significantly higher 24-hour proteinuria and serum creatinine than Grade 2 (P = 0.006 and P = 0.042). RAPS correlated positively with proteinuria (r = 0.68, P < 0.01) and creatinine (r = 0.59, P < 0.05). Conclusions: RAPS and histologic grading provide a consistent evaluation of renal amyloid burden, correlating with clinical severity. Prompt biopsies and standardized reporting can inform prognosis and guide treatment.