Amyloid arthropathy in patients undergoing periodical haemodialysis for chronic renal failure: a new complication.

Abstract

SUMMARY Seven patients (five male and two female) with chronic renal failure (CRF) treated by periodical haemodialysis presented with swelling and effusion of more than three months' duration in knees (four bilateral), shoulders (two, one of them bilateral), elbow (one), and ankle (one). Four had a carpal tunnel syndrome both clinically and electromyographically (three bilateral). All patients had hyperparathyroidism secondary to their CRF, which was not due to amyloidosis in any of them. The dialysis duration period varied from five to 14 years, with an average of 8-6 years. Amyloid deposits (Congo red positive.areas with green birefringence under polarising microscopy) were shown in six of the seven synovial biopsy specimens of the knee, in five of the sediments of the synovial fluids, and in specimens removed during carpal tunnel syndrome surgery. No amyloid was found in the biopsy specimen of abdominal fat of six of the patients. The finding of amyloid only in the synovial membrane and fluid, and carpal tunnel, its absence in abdominal fat, and the lack of other manifestations of generalised amyloidosis (cardiomyopathy, malabsorption syndrome, macroglossia, etc.) and of Bence Jones myeloma (protein immunoelectrophoresis normal) raises the possibility that this is a form of amyloidosis which is peculiar to CRF treated by periodical haemodialysis.

An Assessment of Symptomatic Relief after Carpal Tunnel Release in Patients on Haemodialysis

“…These arthropathies, termed as dialysis-associated arthropathies (DAA), were due to involvement of almost all components of a joint. The changes are seen in almost any joint [5] and were seen as bone cysts, proliferation of synovial lining of the joints, joint capsules and tendons and nerves around it.…”

“…There are known documented contributory factors involved in the pathogenesis of DAA, while others [1,2,3,4,5, 15] did not find a significant relationship between various aetiologies and prevalence of DAA [16]. Using synthetic dialysis membranes, high-flux dialysis, hemodiafiltration and ultra-clean fluids has been proposed in the standardisation of management of patients.…”

“…The causes of symptoms were attributed to the hyperdynamic circulation [1], non-myeloma-associated deposition of amyloid, β 2 -microglobulin [2, 3] and its almost selective association to skeletal system [5], although similar deposits in rectal arteries suggest its multiorgan involvement [3]. The symptoms may also develop due to the lack of use of the hand [1] and can be due to associated uraemia in this group of patients [3].…”

“…Identification of the amyloid protein β 2 -microglobulin in perineural, paratenon and in synovial tissues of the joints has established the systemic involvement of haemodialysis-associated amyloidosis [2,3,4,5]. Patients on long-term haemodialysis showing symptoms of median nerve neuropathy are routinely assessed to diagnose carpal tunnel syndrome or its progression.…”

Dialysis Amyloid Presenting as Acute Arthritis

“…Dialysis amy loid has been associated with chronic arthropathy, bone cysts and recurrent carpal tunnel syndrome [1], The ar thropathy typically presents as bilateral pain and stiff ness in both large and small joints without signs of acute inflammation. We report two cases with an atypical pres entation, i.e.…”