Amyloidosis in Chronic Hemodialysis: Rheumatological Aspects

Beta-2-Microglobulin Amyloidosis in Long-Term Dialysis Patients

“…Bardin et al [3] demonstrated amyloid in the carpal tissues of 17 of 24 (71%) dialysis patients with CTS, and this may represent an average for long-term dialysis patients. Trapping of the ulnar nerve and lumbar roots has also been associated with Ap2ni [11,12], Treat ment of nerve entrapment by surgical decompression is almost uniformly successful if not delayed.…”

“…A chronic arthropathy with pain, noninflammatory swelling and dysfunction of multiple joints has been shown to be related to the capsular and synovial deposi tion of Aj^m [3,6,[12][13][14]. Often this arthropathy accompanies the development of dialysis-associated CTS.…”

“…1). Destructive spondylarthropathies are also seen, usually in the cervical spine and, less commonly, lumbar areas [3,4,12], Neck or low-back pain and stiffness are usual symptoms. Although not strictly an arthropathy, finger flexor tenosynovitis related to A|32m can cause 'trigger finger' and may require surgical release [3,6].…”

“…In affected patients, routine skeletal surveys show cys tic radiolucencies in periarticular bone and the shaft of long bones, destructive arthropathies with subchondral bone demineralization preceding joint space narrowing by several years and pathologic fractures, mainly of the hip [4,12,16], Identified lesions enlarge over a period of months to years. Multiple adjacent cystic lesions may coalesce over time to form a larger one.…”

“…Using data with respect to CTS in chronic hemodialysis pa tients, uniform development of Ap2m will occur some where between 10 and 20 years of therapy with cellulosic dialyzers. Important risk factors hastening the clinical appearance of Ap2m are loss of residual renal function, sole use of cellulosic hemodialysis membranes and age at the onset of hemodialysis over 40 years [4,12]. The fac tors involved in polymerization and deposition of p2m in tissue remain unknown.…”