Historical background and clinical treatment of dialysis-related amyloidosis.
Dialysis-related amyloidosis (DRA) is a frequent and serious complication in patients on long-term dialysis. The amyloid has a marked affinity for joint tissues, and carpal tunnel syndrome, polyarthralgia, destructive spondyloarthropathy, and bone cysts are the major clinical manifestations of DRA. beta(2)-Microglobulin (beta(2)-m) was identified as the major protein constituent of the amyloid fibrils. Risk factors for the development of DRA include age, duration of dialysis treatment, use of low-flux dialysis membrane, use of low purity dialysate, monocyte chemoattractant protein-1 GG genotype, and apolipoprotein E4 allele, although the retention of beta(2)-m in the plasma appears to be prerequisite. Clinical therapeutic strategies for DRA include dialysis, medical or surgical therapy, and renal transplantation. Preventive measures have attempted to remove beta(2)-m from the serum by using high-flux membranes and a beta(2)-m adsorption column in hemodialysis. Renal transplantation is a radical approach to treating the arthralgias attributed to the amyloid deposits while the regression of dialysi-related amyloid deposits is not identified after successful renal transplantation in many studies. It is necessary to elucidate the pathogenesis of DRA and to establish more effective prevention and therapy in the future.
Yamamoto
Suguru
S
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, 757 Asahimachi-dori, Niigata 951-8510, Japan.
Gejyo
Fumitake
F
D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D002349:Carpal Tunnel Syndrome / Q000209:etiology / Q000601:surgery; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D001613:beta 2-Microglobulin / Q000097:blood / Q000378:metabolism
D001613:beta 2-Microglobulin