Atypical rapid progression of osteoarticular amyloidosis involving the hip in a patient on hemodialysis using polyacrylonitrile membranes

• Published in: Skeletal radiology 2010, Vol.39 (1), p.79-83
• Main Authors: Lee, Kenneth S., van Holsbeeck, Marnix T., Abbud, Alexander
• Format: Article
• Language: English
• Subjects: Acrylic Resins; Aged; Amyloidosis; Amyloidosis - complications; Amyloidosis - physiopathology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Diseases - complications; Bone Diseases - physiopathology; Case Report; Diagnosis; Diagnosis, Differential; Dialysis; Emergency and intensive care: renal failure. Dialysis management; Fractures, Bone - diagnostic imaging; Hip Injuries - diagnostic imaging; Humans; Imaging; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Kidney diseases; Male; Medical colleges; Medical sciences; Medicine & Public Health; Membranes, Artificial; Metabolic diseases; Nuclear Medicine; Orthopedics; Osteoarticular system. Muscles; Other metabolic disorders; Pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Radiology; Renal Dialysis; Ultrasonography
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-009-0779-6

Amyloidosis related to dialysis is a well-known complication affecting many organ systems, in particular the musculoskeletal system. In 1985 Shirahama et al. (Biochem Biophys Res Commun 53:705-709, 1985 ) identified beta-2 microglobulin (MG) as the offending constituent by using protein purification techniques. Amyloidosis has been increasing in prevalence because of longer life spans and increased chronic medical conditions such as end-stage renal disease. When dialysis-related amyloidosis involves the musculoskeletal system, it affects the shoulder girdle, the so called shoulder pad sign, the wrist, hip, knee, and spine (Resnick, Diagnosis of bone and joint disorders, 4th edn. , pp. 2054–2058 and 2176–2183, 2002 ). Other osteoarticular manifestations of amyloidosis include osteoporosis, lytic lesions, and pathologic fractures. It has been well documented that the prevalence of amyloid is dependent on duration of dialysis—over 90% in patients on dialysis for over 7 years (Jadoul, Nephrol Dial Transplant 13:61–64, 1998 ). However, a recent changeover to high-flux membranes used in hemofiltration has been reported to delay its onset (Campistol et al., Contrib Nephrol 125:76-85, 1999 ). We report on the radiographic, nuclear medicine, and computed tomography (CT) findings of osteoarticular amyloidosis involving the hip, and sequence its atypical rapid onset. The imaging, histopathological findings, and differential diagnosis are discussed.