β2 Microglobulin-Derived Amyloid in Dialysis Patients

  • E. Ritz
  • R. Deppisch
  • G. Stein
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 260)

Abstract

In the recent past, a whole spectrum of osteoarticular problems has been recognized in patients on longterm hemodialysis. After the recognition by Assenat et al. (1) of amyloid-related carpal tunnel syndrome in hemodialysis patients whose primary renal disease had not been amyloidosis, many reports confirmed its high prevalence in dialysis patients (2). In addition, joint pain, joint swelling and recurrent hemarthros were recognized as the consequence of synovial amyloid deposits (3) which had many similarities with articular amyloidosis of the AL type (4). Finally, amyloid containing bone cysts, pathological fractures (5) and destructive arthropathy in the appendicular or axial skeleton (6) were noted with increasing frequency. Todate, this new form of amyloid has not been demonstrated in non-dialysed uremic patients. However, in patients with preterminal renal failure, similar amyloid has been recognized as a structural component of matrix stones either within the kidney or passed into the urine (7,8). While extrarenal amyloid, todate, has only been demonstrated in patients on renal replacement therapy, i. e. hemodialysis, hemofiltration or CAPD (9), it is unknown whether the phenomenon is causally related to these treatment modalities or whether it merely reflects longer patients survival and continued exposure to risk. It came as a major breakthrough when such amyloid could be characterized at the molecular level by Gejyo(10). He documented that these amyloid fibrils are derived from the circulating precursor molecule beta-2-microglobulin (β2 m). The clinical problems of dialysisrelated amyloid have been reviewed extensively elsewhere (9, 11). This communication will mainly discuss problems of pathogenesis and treatment.

Keywords

Arthritis Lysine Polypeptide Interferon Biodegradation 

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Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • E. Ritz
    • 1
    • 2
  • R. Deppisch
    • 1
    • 2
  • G. Stein
    • 1
    • 2
  1. 1.Department Internal MedicineRuperto-Carola-UniversityHeidelbergGermany
  2. 2.Klinik für Innere MedizinFriedrich Schiller-Universität JenaGermany

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