Amyloid Deposits and Maintenance Haemodialysis

Dr. N.R.B. Cary, Department of Histopathology and Experimental Pathology, Charing Cross Hospital, Fulham, London W6 8RF (UK) Dear Sir, There has been considerable recent interest in the occurrence of amyloid deposits in patients on maintenance haemodialysis. It has been suggested that such amyloid deposits may be responsible for a variety of rheumatological complaints that occur in these patients [1–4], including the carpal tunnel syndrome and arthropa-thies of large joints such as the shoulders, hips and knees. However, it should be borne in mind that amyloid deposits in a variety of organs are a very common age-related phenomenon [5], even in quite large quantities, and such deposits are well recognised in juxta-articular tissues including cartilage and synovium [6, 7]. It may be that maintenance haemodialysis patients develop these amyloid deposits more frequently and at a relatively early age; either due to an increased production or due to a decreased breakdown or excretion of precursor substances. It would be premature to assume that amyloid deposits in these patients are necessarily related to the pathogenesis of the carpal tunnel syndrome or other rheumatological complaints. The presence of amyloid in tissues from patients on maintenance haemodialysis may represent no more than an accelerated age change. References 1 Herve, J.P.; Cledes, J.; Bourbigot, B.; Guillodo, M.P.; Legrand, O.; Pennec, Y.; Youinou, P.; Leroy, J.P.: Systemic amyloidosis in the course of maintenance haemodialysis. Nephron 40:494 (1985). Walts, A.E.; Goodman, M.D.; Matorin, P.A.: Amyloid, carpal tunnel syndrome and chronic haemodialysis. Am. J. Nephrol. 5: 225–226 (1985). Zingraff, J.; Bardin, T.; Kuntz, D.; Voisin, M.C.; Drüeke, T.: Degenerative osteoarticular lesions and amyloid infiltration in long-term haemodialysis patients. Xllth Congr. Europ. Dialysis and Transplant Assoc. Kidney int. 28:246 (1985). Vandenbroucke, J.M.; Huaux, J.P.; Guillaume, Th.; Noel, B.; Maldague, B.; van Ypersele de Stridou, C: Capsulo-synovial and bone amyloidosis: complication of long-term haemodialysis (Abstract ). X∏th Congr. Europ. Dialysis and Transplant Assoc. Kidney int. 2S:360 (1985). Ishii, T.; Hosoda, Y.; Ikegami, N.; Hiroyuki, S.: Senile Amyloid deposition. J. Path. 139:1–22 (1983). Mitrovic, D.R.; Stankovic, A.; Quintero, M.; Ryckewaert, A.: Amyloid deposits in human knee and hip joints. Rheumatol. Int. 5:83–89(1985).