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Imaging of haemodialysis-associated amyloidosis with 123I-serum amyloid P component
S R Nelson1, P N Hawkins, S Richardson
1Immunological Medicine Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Abstract:
Long-term haemodialysis is frequently complicated by amyloid deposition in which the fibrils consist of beta 2-microglobulin. Dialysis-related amyloid disease causes extensive morbidity and has been associated with deaths in some cases. All amyloid deposits contain amyloid P component that is derived from the normal circulating protein, serum amyloid P component (SAP). We have used scintigraphic imaging after injection of 123I-labelled SAP to assess the distribution of amyloidosis in 38 patients receiving long-term haemodialysis for end-stage renal failure. There was focal localisation of tracer at all sites where histological examination confirmed amyloid deposition. Splenic uptake was seen in 12 patients, indicating splenic amyloidosis, but there was no evidence of other visceral involvement. 6 control subjects who had been dialysed for under 1.5 years showed no localisation of tracer, nor was there any uptake of 123I-labelled human serum albumin in 3 long-term dialysis patients with histologically confirmed amyloidosis and positive 123I-SAP images. Negative scans were also obtained in 5 patients who had been transplanted 0.8-2.4 years previously, despite past evidence of dialysis arthropathy (5) and histologically proven amyloidosis (4). 123I-SAP scintigraphy may be helpful as a non-invasive method for both the diagnosis and monitoring of dialysis-associated amyloidosis.
Insights
Long-term hemodialysis can cause amyloidosis due to beta 2-microglobulin. 123I-labelled serum amyloid P component (SAP) scintigraphy effectively diagnoses and monitors this condition in dialysis patients.
Area of Science:
- Nephrology
- Nuclear Medicine
- Pathology
Background:
- Long-term hemodialysis is often complicated by beta 2-microglobulin amyloid deposition, leading to significant morbidity and mortality.
- Dialysis-related amyloid disease affects multiple tissues, necessitating reliable diagnostic and monitoring tools.
Purpose of the Study:
- To evaluate the utility of 123I-labelled serum amyloid P component (SAP) scintigraphy for diagnosing and monitoring dialysis-associated amyloidosis.
Main Methods:
- 38 patients on long-term hemodialysis underwent scintigraphic imaging with 123I-SAP.
- Histological examination confirmed amyloid deposition at sites of tracer localization.
- Control groups included patients with short-term dialysis, transplanted patients, and those with confirmed amyloidosis imaged with 123I-human serum albumin.
Main Results:
- Focal tracer localization correlated with histologically confirmed amyloid deposits.
- Splenic amyloidosis was identified in 12 patients.
- No visceral involvement was detected, and scans were negative in short-term dialysis and transplanted patients.
Conclusions:
- 123I-SAP scintigraphy is a valuable non-invasive method for diagnosing dialysis-associated amyloidosis.
- The technique can also be used to monitor the progression and distribution of amyloid deposits.
- It shows potential for clinical application in managing patients with end-stage renal failure undergoing long-term hemodialysis.
