Dialysis-associated amyloid: systemic or local?
Dialysis-associated amyloidosis has been classified as one of the local amyloidoses. To test this, we examined post-mortem tissue from 14 long-term haemodialysis patients, ten with dialysis arthropathy and four without arthropathy. Tissue was obtained from the shoulder, knee, or hip joints and the following organs: brain, kidney, liver, heart, lung, spleen, and rectum. Congo-red stain was used to identify amyloid deposits and these were characterised further using an indirect immunoperoxidase technique with antibodies to beta 2-M, prealbumin, serum amyloid A protein, and kappa and lambda light chains. All patients with arthropathy had large deposits of beta 2-M amyloid in the articular tissues. In contrast to this, systemic amyloid deposits were only found in four patients and were small and mainly confined to vessel walls. The four patients without joint symptoms had no evidence of systemic or articular amyloidosis. In addition, subcutaneous fat aspirations were carried out in 13 patients with dialysis arthropathy and 12 without arthropathy. Amyloid deposits were only found in two patients with arthropathy. Our results show that dialysis-associated amyloidosis has a predilection for deposition in articular tissues, and that systemic deposits are infrequent, small, and mainly confined to vessel walls. The discrepancy between our post-mortem series and case reports describing large systemic deposits may be due to differences in patient susceptibility.
Sethi
D
D
Charing Cross Hospital, London, UK.
Cary
N R
NR
Brown
E A
EA
Woodrow
D F
DF
Gower
P E
PE
D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000686:Amyloidosis / Q000209:etiology* / Q000473:pathology; D001847:Bone Diseases / Q000209:etiology / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D013194:Staining and Labeling