Amyloid arthropathy of renal failure

What is amyloid arthropathy of renal failure?

β2- microglobulin is an endogenous structural protein (molecular weight = 11.8 kDa) that is poorly cleared by standard dialysis membranes and accumulates to extremely high levels in patients on long-term hemodialysis. Owing to its high affinity for collagen, β2-microglobulin deposits in bones, joints, and synovium. These deposits can lead to chronic arthralgias and carpal tunnel syndrome. This chronic arthropathy most commonly involves the shoulder, hip, wrist and finger tendon sheaths, and rarely the spine (especially cervical). Rotator cuff and subacromial bursae deposition leads to impingement syndrome.

Synovial fluid is noninflammatory but may be hemorrhagic as a result of anticoagulation use during dialysis. Synovial fluid or biopsy will identify amyloid fibrils when stained with Congo red. Radiographs are notable for erosions and large subchondral bony cysts that tend to occur at the ends of long bones (humerus, femur, tibia, and carpals). The use of more permeable, high-flux membranes may delay the onset of disease but does not prevent disease development (see Chapter 73 : Amyloidosis).


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