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Dialysis-associated amyloid: systemic or local?

D Sethi1, N R Cary, E A Brown

  • 1Charing Cross Hospital, London, UK.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|January 1, 1989
PubMed
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Dialysis-associated amyloidosis primarily affects joints, not systemic organs, in long-term hemodialysis patients. Beta 2-microglobulin amyloid deposits are common in affected joints but rare systemically.

Area of Science:

  • Nephrology
  • Rheumatology
  • Pathology

Background:

  • Dialysis-associated amyloidosis is often considered a local condition.
  • Beta 2-microglobulin (β2M) is implicated in amyloidosis in hemodialysis patients.

Purpose of the Study:

  • To investigate the distribution and characteristics of amyloid deposits in long-term hemodialysis patients.
  • To determine if dialysis-associated amyloidosis is predominantly local or systemic.

Main Methods:

  • Post-mortem tissue analysis from 14 hemodialysis patients (10 with and 4 without arthropathy).
  • Examination of joint tissues (shoulder, knee, hip) and systemic organs (brain, kidney, liver, heart, lung, spleen, rectum).
  • Congo-red staining and immunoperoxidase techniques using antibodies against β2M, prealbumin, serum amyloid A, and immunoglobulin light chains.

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Main Results:

  • All patients with dialysis arthropathy exhibited significant β2M amyloid deposits in articular tissues.
  • Systemic amyloid deposits were infrequent, small, and primarily located in vessel walls in only four patients.
  • No amyloid evidence was found in patients without joint symptoms.
  • Subcutaneous fat aspirations revealed amyloid deposits in only two patients with arthropathy.

Conclusions:

  • Dialysis-associated amyloidosis shows a strong predilection for articular tissues.
  • Systemic amyloid deposition is uncommon and typically minimal in hemodialysis patients.
  • Observed differences from previous reports may stem from variations in patient susceptibility and study methodology.