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Analysis of previously unexplained syndromes in patients with primary systemic amyloidosis at the time of diagnosis in an 11-year study at the Mayo Clinic. Nephrotic syndrome or renal failure was present in 28% of patients, congestive heart failure (CHF) in 17%, and carpal tunnel syndrome in 21%. Peripheral neuropathy and orthostatic hypotension also were common features. The possibility of primary systemic amyloidosis must be considered in every patient who has monoclonal protein in the serum or urine and who has unexplained nephrotic syndrome, CHF, sensorimotor peripheral neuropathy, carpal tunnel syndrome, hepatomegaly, or malabsorption. (Adapted from Kyle and Gertz [5]; with permission.)

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