Dialysis-related amyloidosis of the hip joints in long-term hemodialysis patients-MRI findings of hip joints in twelve female hemodialysis patients-

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  • Suzuki Hitoe
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital
  • Shibuya Asuka
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital
  • Akiba Takashi
    Division of Blood Purification, Tokyo Women's Medical University
  • Nitta Kosaku
    Department of Internal Medicine, Tokyo Women's Medical University
  • Ando Minoru
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital

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Other Title
  • 長期血液透析患者に認められる透析アミロイド股関節病変―女性血液透析患者１２例のＭＲＩスクリーニング結果―
  • チョウキ ケツエキ トウセキ カンジャ ニ ミトメラレル トウセキ アミロイド コカンセツ ビョウヘン ジョセイ ケツエキ トウセキ カンジャ 12レイ ノ MRI スクリーニング ケッカ
  • —MRI findings of hip joints in twelve female hemodialysis patients—
  • ―女性血液透析患者12例のMRIスクリーニング結果―

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Abstract

We report a female with amyloid arthropathy of the hip joints. She was a 67-year-old woman who had been treated by hemodialysis for 22 years. She had demonstrated a 5-month history of continuous low-grade fever and pain in her left hip and she was finally unable to walk by herself. Findings on X-ray films and MRI of the hip joints suggested avascular necrosis in both femur heads. To palliate symptoms, bipolar surgery on the left hip joint was performed. Pathological examination of bone tissue specimen demonstrated that there was some β2-microglobulin (β2-MG)-related amyloid accumulation in the femur head. Based on this clinical experience, we performed MRI screening for amyloid lesions of the hip joints in another 11 asymptomatic female patients undergoing hemodialysis for 20 years or more. Cystic lesions of the hip joints were observed in 8 patients, amyloid arthropathy in 2 patients, and fluid trapped in the joint in 1 patient. Patients with amyloidosis had significantly lower serum β2-MG levels than patients without amyloidosis (28.6 mg/L versus 41.4 mg/L ; p=0.0339). Our findings show that dialysis-related amyloidosis of the hip joints is one of the potential and significant problems in female patients on long-term hemodialysis therapy. It may be important to screen for this pathological condition in long-term hemodialysis patients.

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