| [ Summary ] |
In chronic renal failure and dialysis patients, two types of articular disturbances have been classified, crystal deposition lesions and “dialysis arthropathy”, associated with dialysis -related amyloidosis (DRA). In the former type, calcium phosphate (ectopic calcification), uric acid (gout arthropathy), and pilo-phosphate (psedo-gout) are involved. The latter type associated with DRA is a dialysis-specific complication. The formation of amyloid proteins is thought to be caused by abundant β2-microglobulin in the uremic plasma. The amyloid proteins also contain apolipoproteins, α2-macroglobulin, amyloid P components, proteoglycan, and glucosaminoglycan. Advanced glycation end products are seen as modification factors for protein fibrils. Macrofages and the cytokines are thought to induce tissue inflammation causing the destructive bone and joint lesions. However, critical and optimal plasma levels for amyloidforming and modifying substances are not fully known. |