Dialysis‐Related Amyloidosis: History and Clinical Manifestations

Abstract

Dialysis-related amyloidosis (DRA) or beta(2)-microglobulin amyloidosis (A beta(2)M) is a unique type of amyloidosis that has been described in individuals with both long-standing chronic renal disease and end-stage renal disease (ESRD). It has been associated with serious complications that significantly add to the morbidity of long-term dialysis patients. The deposition of beta(2)M in amyloid fibrils in various joint and osteoarticular surfaces leads to the clinical complaints and findings typical of this disorder. However, a visceral form with systemic organ involvement has also been described. Despite advances in the understanding of this disorder and in the delivery of dialysis, the ability to alter the incidence of DRA and its course remains uncertain.

The Role of Ultrasonographic Monitoring for Hip Joint Changes in Patients with Chronic Renal Failure

“…In the present study, we found no statistically significant difference in β2-microglobulin concentration among the three patient age groups, nor recorded any effect of age on morphological changes in the hip area. There are literature reports on the carpal tunnel syndrome, amyloid arthropathy and amyloid bone cysts to be more common in elderly patients (Denesh & Ho, 2001;Shin et al, 2008). The mechanism by which patient age influences the prevalence of complications in hemodialysis patients remains unknown.…”

Efeito da estimulação elétrica nervosa transcutânea no tratamento da dor no ombro de pacientes com doença renal crônica: relato de casos

“…A dor no ombro decorrente do depósito de amilóide nos tecidos ocorre pela infiltração de células inflamatórias que favorece o desenvolvimento de bursite, tenossinovite e também erosão óssea 3 .…”

“…Esses depósitos favorecem inflamação e erosão da articulação, levando à dor e perda da movimentação osteoarticular 3 . As principais manifestações clí-nicas da amiloidose são a síndrome do túnel do carpo, artropatia crônica e lesões císticas ósseas, sendo que o ombro e o punho são as articulações mais acometidas 3,4 .…”

“…Esses depósitos favorecem inflamação e erosão da articulação, levando à dor e perda da movimentação osteoarticular 3 . As principais manifestações clí-nicas da amiloidose são a síndrome do túnel do carpo, artropatia crônica e lesões císticas ósseas, sendo que o ombro e o punho são as articulações mais acometidas 3,4 . Não há tratamento específico e o uso de analgésicos, anti-inflamatórios e corticosteróides são úteis no alívio dos sintomas, mas essas medicações apresentam efeitos colaterais severos 4 .…”

Oral Localized Amyloidosis

“…Another type of secondary amyloidosis may occur in patients undergoing dialysis. In these patients, β2 microglobulin, which is part of the Class I major histocompatibility complex antigen, fails to cross the dialysis membrane, resulting in amyloid fibril formation (Danesh and Ho, 2001). These fibrils may be deposited in joints, (resulting in arthritis), periarticular tissue (resulting in carpal tunnel syndrome), and in bones (resulting in cysts) (Khan and Falk, 2001).…”