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Volume 68, Issue 5, Pages 1994-1998 (November 2005) Hereditary amyloidosis in early childhood associated with a novel insertion-deletion (indel) in the fibrinogen Aα chain gene Hee Gyung Kang, Alison Bybee, Il Soo Ha, Moon Soo Park, Janet A. Gilbertson, Hae Il Cheong, Yong Choi, Philip N. Hawkins Kidney International Volume 68, Issue 5, Pages 1994-1998 (November 2005) DOI: 10.1111/j.1523-1755.2005.00653.x Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 1 Renal biopsy. Hematoxylin and eosin (A) stain and electron micrograph (B) show greatly enlarged glomeruli substantially replaced by amyloid, further confirmed in Congo Red stain (C) and the same section viewed under crossed polarized light (D) showing typical apple green birefringence. Kidney International 2005 68, 1994-1998DOI: (10.1111/j.1523-1755.2005.00653.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 2 Sequence (reverse complement) trace of part of exon 5 of fibrinogen Aα chain gene. (A) Direct sequence of polymerase chain reaction (PCR) product from the patient. (B) The mutant allele cloned into plasmid with insertion boxed and the final unmutated nucleotide (arrow). (C) The cloned normal allele from the patient showing the portion deleted from the mutant allele (bold box). Kidney International 2005 68, 1994-1998DOI: (10.1111/j.1523-1755.2005.00653.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 3 Congo Red–positive glomerular amyloid deposits (A) and adjacent tissue section stained both with Congo Red and with antibodies to fibrinogen protein (B). Kidney International 2005 68, 1994-1998DOI: (10.1111/j.1523-1755.2005.00653.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 4 An alignment of known mutations in part of exon 5 of the fibrinogen Aα chain gene. Locations of amyloidogenic (bold italic) mutations and other nonamyloidogenic pathogenic mutations in genetic proximity to the new insertion and deletion (indel). Italics are nonamyloidogenic; WT is partial wild-type normal sequence; numbers to left are amino acid locations of deletions; Numbers above WT sequence show point mutations reported in the region. |Homology; *Termination codon; (-) spaces inserted to allow alignment. Kidney International 2005 68, 1994-1998DOI: (10.1111/j.1523-1755.2005.00653.x) Copyright © 2005 International Society of Nephrology Terms and Conditions