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Dialysis-Related Beta-2m Amyloidosis Differential Diagnoses

  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: May 01, 2014
 
 

Diagnostic Considerations

Secondary hyperparathyroidism

Secondary hyperparathyroidism is the most common bone disease found in patients with end-stage renal disease. Bone erosions, tendon ruptures, and osteosclerosis can be the source of bone pain or polyarthralgias.

Renal osteodystrophy

DRA bone lesions differ from renal osteodystrophy in that in DRA, the presence of the amyloid deposits interferes with normal bone-tissue dynamics, while in renal osteodystrophy, the abnormality is in the underlying metabolic process itself, causing bone turnover to be either increased or decreased.

In the case of pathologic fractures in patients on dialysis, it is essential that DRA be distinguished from renal osteodystrophy, because there are implications for healing.

Aluminum overload

Patients with end-stage renal disease sometimes receive aluminum-containing antacids to control serum phosphate levels. Absorbed aluminum can be toxic to osteoblasts, leading to the development of osteomalacia.

Dupuytren contracture

Dupuytren contracture is a type of palmar fasciitis observed in people with chronic alcoholism or chronic diabetes.

Other forms of amyloidosis

Types of amyloidosis to consider in the differential diagnosis of beta-2m amyloidosis include the following:

  • Familial renal amyloidosis
  • Immunoglobulin-related amyloidosis
  • Transthyretin-related amyloidosis
 
 
Contributor Information and Disclosures
Author

Anita Basu, MD, FACP Assistant Professor of Medicine, University of Mississippi School of Medicine; Staff Nephrologist, GV (Sonny) Montgomery Veterans Affairs Medical Center

Anita Basu, MD, FACP is a member of the following medical societies: American College of Physicians, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Carol A Bogdan, MD Consultant in Hematology-Oncology, Myrtle Beach, SC

Disclosure: Nothing to disclose.

Reynaldo Matute, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Nephrology, New York Medical College

Reynaldo Matute, MD is a member of the following medical societies: American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

George R Aronoff, MD Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Donald A Feinfeld, MD, FACP, FASN Consulting Staff, Division of Nephrology & Hypertension, Beth Israel Medical Center

Donald A Feinfeld, MD, FACP, FASN is a member of the following medical societies: American Academy of Clinical Toxicology, American Society of Hypertension, American Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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