| Theme |
Amyloid-Related Bone and Joint Derangements -- Clinical Diagnosis and Treatment |
| Title |
Renal transplantation for dialysls-related amyloid arthropathy |
| Author |
Yoshihiro Tominaga |
Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital |
| Author |
Kazuharu Uchida |
Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital |
| Author |
Hiroshi Takagi |
Department of Surgery II, Nagoya University School of Medicine |
| [ Summary ] |
It is well recognized that dialysis-related amyloid arthropathy (DRAA), which is induced by retention of beta2 microglobulin (beta2-MG), is one of the most serious complications experienced by long-term hemodialysis patients. After successful renal transplantation, serum levels of beta2-MG rapidly drop to within normal range and cutaneous deposits of beta2-MG can reportedly be removed. Renal transplantation consistently provides rapid relief of multiple joint pain due to DRAA. The effect appears to be due mainly to the antiinflammatory action of steroids.
As neither enlargement of bone cysts nor new cyst development is detected, renal transplantation can prevent progression of DRAA. However, radiologic findings of bone cysts and destructive spondyloarthropathy, as well as changes of shoulder joints due to amyloid arthropathy detected by MRI, reportedly do not change after renal transplantation. Amyloid deposition in joint structures is still histopathologically detectable 10 years after renal transplantation. Successful early transplantation clearly prevents DRAA. Furthermore, in patients with already established DRAA, renal transplantation is the preferred treatment, because transplantation arrests the progression of radiologic signs of DRAA, as well as relieving its symptoms. |