| Theme | Cytokines and Dialysis Treatment | |
|---|---|---|
| Title | Dialysis related amyloidosis | |
| Publish Date | 2007/04 | |
| Author | Noriko Saito | Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University |
| Author | Shigeru Miyazaki | Kidney Center, Shinrakuen Hospital |
| [ Summary ] | Dialysis related amyloidosis (DRA) is one of the most serious complications in patients on long term dialysis. β2-microglobulin (β2-m) amyloid has a marked affinity for joint tissues. The major clinical manifestations of DRA are carpal tunnel syndrome, polyarthralgia, destructive spondyloarthropathy and bone cysts. Stimulated complements produced by contact with dialysis membranes and endotoxins in dialysate activate macrophages (MΦs) produce inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF-α). These cytokines are considerd to play pivotal roles in the development of DRA. Histologically, amyloid deposits are surrounded by MΦs and other inflammatory cells. The MΦs are positive for IL-1 and TNF-α. Amyloid deposition and the reactive inflammation produced by cytokines leads to bone / joint destruction. DRA is prevented by removing large amounts of β2-m from the serum without stimulating the production of inflammatory cytokines. The preventive measures used are the utilization of high flux membranes, which eliminate higher molecular weight solutes and produce better biocompatibility, as well as ultra-pure dialysates, hemodiafiltration and early phase kidney transplantation. These measures are important not only to prevent DRA, but to prolong the survival of dialysis patients as well. |
|