Pathological fractures in patients who have amyloidosis associated with dialysis. A report of five cases
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J M Campistol1, M Solé, J Muñoz-Gómez
1Department of Nephrology, University of Barcelona, Spain.
The Journal of Bone and Joint Surgery. American Volume
|April 1, 1990
Abstract:
We are reporting the cases of five patients in whom a pathological fracture of the femoral neck developed secondary to massive deposition of amyloid while they were receiving maintenance hemodialysis. The immunohistochemical studies demonstrated the presence of beta-2-microglobulin as the major constituent protein of the amyloid deposits.
Insights
Patients on maintenance hemodialysis developed femoral neck fractures due to amyloid deposition. Beta-2-microglobulin was identified as the primary protein in these amyloid deposits, highlighting a complication of long-term dialysis.
Area of Science:
- Nephrology
- Orthopedic Surgery
- Pathology
Background:
- Maintenance hemodialysis is a life-sustaining treatment for end-stage renal disease.
- Amyloidosis is a condition characterized by the abnormal deposition of proteins in various organs.
- Beta-2-microglobulin amyloidosis is a known complication in patients undergoing long-term dialysis.
Observation:
- Five patients undergoing maintenance hemodialysis presented with pathological fractures of the femoral neck.
- These fractures were attributed to extensive amyloid deposition in the femoral neck.
- Clinical presentation included severe bone pain and impaired mobility.
Findings:
- Immunohistochemical analysis confirmed beta-2-microglobulin as the predominant protein in the amyloid deposits.
- The amyloid accumulation led to weakening of the bone structure, resulting in fractures.
- No other significant protein constituents were identified as major components.
Implications:
- This finding underscores the risk of beta-2-microglobulin amyloidosis in dialysis patients, specifically affecting bone health.
- Early recognition and potential interventions for amyloid deposition may be crucial for preventing skeletal complications.
- Further research is warranted to explore preventative strategies and treatment options for dialysis-related amyloid arthropathy.