Diagnostic assessment of patients with PN and monoclonal gammopathy
| 1. Complete medical history |
| 2. Physical/neurological exam |
| 3. PN characterization: nerve conduction studies and electromyography |
| 4. Monoclonal gammopathy characterization: a. Renal function, serum calcium, and complete blood count b. Serum/urine protein electrophoresis and immunofixation c. Serum Ig levels d. Serum free light chain levels e. 24-h urine excretion f. Bone marrow aspirate and/or biopsy: morphology, flow cytometry, molecular and cytogenetic analysis based on findings, such as MYD88 L265P mutation analysis in IgM MGUS, and FISH for t(11;14) in AL amyloidosis |
| 5. Other investigations according to previous findings: a. Serum cobalamin levels b. Cryoglobulins c. Testing for HIV, HCV, and, if indicated, syphilis and Lyme disease d. Autoantibodies: antinuclear antibodies, anti-MAG, and, if required, anti-HNK1, anti-GM1, disialosil ganglioside or anti-sulfatides antibodies e. Serum levels of VEGF f. Endocrine screening of the 4 major endocrine axes: gonadal, thyroid, glucose metabolism, and adrenal g. Imaging assessment: skeletal survey, MRI, CT, or positron emission tomographic CT h. Cardiac evaluation: serum troponin and NT-proBNP levels, electrocardiogram, echocardiography, and/or MRI i. Fat pad aspiration with Congo red staining and, if positive, amyloid typing j. Nerve biopsy |
| 1. Complete medical history |
| 2. Physical/neurological exam |
| 3. PN characterization: nerve conduction studies and electromyography |
| 4. Monoclonal gammopathy characterization: a. Renal function, serum calcium, and complete blood count b. Serum/urine protein electrophoresis and immunofixation c. Serum Ig levels d. Serum free light chain levels e. 24-h urine excretion f. Bone marrow aspirate and/or biopsy: morphology, flow cytometry, molecular and cytogenetic analysis based on findings, such as MYD88 L265P mutation analysis in IgM MGUS, and FISH for t(11;14) in AL amyloidosis |
| 5. Other investigations according to previous findings: a. Serum cobalamin levels b. Cryoglobulins c. Testing for HIV, HCV, and, if indicated, syphilis and Lyme disease d. Autoantibodies: antinuclear antibodies, anti-MAG, and, if required, anti-HNK1, anti-GM1, disialosil ganglioside or anti-sulfatides antibodies e. Serum levels of VEGF f. Endocrine screening of the 4 major endocrine axes: gonadal, thyroid, glucose metabolism, and adrenal g. Imaging assessment: skeletal survey, MRI, CT, or positron emission tomographic CT h. Cardiac evaluation: serum troponin and NT-proBNP levels, electrocardiogram, echocardiography, and/or MRI i. Fat pad aspiration with Congo red staining and, if positive, amyloid typing j. Nerve biopsy |
FISH, fluorescence in situ hybridization; HCV, hepatitis C virus; MRI, magnetic resonance imaging; NT-proBNP, N-terminal pro b-type natriuretic peptide.