Marc D. Cohen, MD
Division of Rheumatology
Mayo Clinic
Jacksonville, FL

Dialysis-Related Amyloidosis

Dialysis related-amyloidosis (DRA) occurs in patients on hemo- or peritoneal dialysis as a result of accumulation of polymers of b-2 microglobulin (5). Interestingly, the risk of developing amyloidosis is not strongly correlated with the serum b-2 microglobulin level (18), but may be related to the dialysis membrane used (19). The pathogenesis is believed to be related to deposition (as amyloid fibrils) of polymeric b-2 microglobulin, which has been modified by advanced glycation end products (20).

The symptoms are predominantly articular or periarticular most commonly about the wrists, shoulders, hips, and knees, and less commonly about the small joints of the hands and the intervertebral disks (21). The spine may be involved with a destructive spondyloarthropathy or spinal stenosis due to dural thickening from amyloid deposits.

Carpal tunnel syndrome is often the first manifestion of DRA. Treatment of the entire syndrome is symptomatic, but in the event that large joint replacement is undertaken, one must recognize that morbidity and mortality are high in this population (22). Renal transplantation may ameliorate symptoms of DRA, but the histologic changes remain (23).