eMedicine Specialties > Nephrology > The Kidney in Systemic Diseases

Amyloidosis, Beta2M (Dialysis-Related): Follow-up

Author: Anita Basu, MD, Assistant Professor of Medicine, University of Mississippi School of Medicine; Staff Nephrologist, GV (Sonny) Montgomery Veterans Affairs Medical Center
Coauthor(s): Carol A Bogdan, MD, Consulting Staff, Coastal Cancer Center, Myrtle Beach, SC; Reynaldo Matute, MD, Clinical Assistant Professor, Department of Internal Medicine, Division of Nephrology, New York Medical College
Contributor Information and Disclosures

Updated: Feb 22, 2008

Follow-up

Further Outpatient Care

  • A nephrologist should care for patients with beta-2-microglobulin amyloidosis on an ongoing basis.

Deterrence/Prevention

  • Although this is hard to assess, possible ways of preventing or at least of decreasing the incidence of DRA are the use of a high-flux dialyzer, online hemodiafiltration, and ultrapure dialysate and adsorbent columns.
  • Based on the Disease Outcomes Quality Initiative (DOQI) guidelines, there is no indication for routine monitoring of beta-2-microglobulin.

Complications

  • The most severe complication involves beta-2-microglobulin amyloid deposits destroying paravertebral ligaments and intervertebral discs, which can result in paraplegia.
  • Cardiac involvement with subsequent fatal arrhythmias and massive GI bleeding has been described.

Prognosis

  • The prognosis of beta-2-microglobulin amyloidosis depends on the duration of dialysis, the age of the patient, the age of the patient at the start of dialysis, and the type of dialysis membrane that is used. Ultimately, residual renal function is probably the best determinant of beta-2-microglobulin levels in HD patients and may supersede enhanced convective clearance by hemodiafiltration.

Miscellaneous

Medicolegal Pitfalls

  • The physician must be certain that the type of amyloidosis has been determined definitively.
  • Involve rheumatologic, surgical, and transplant consultants early.
 


More on Amyloidosis, Beta2M (Dialysis-Related)

Overview: Amyloidosis, Beta2M (Dialysis-Related)
Differential Diagnoses & Workup: Amyloidosis, Beta2M (Dialysis-Related)
Treatment & Medication: Amyloidosis, Beta2M (Dialysis-Related)
Follow-up: Amyloidosis, Beta2M (Dialysis-Related)
References
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References

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Further Reading

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Keywords

dialysis-related amyloidosis, DRA, hemodialysis-associated amyloidosis, beta2 -microglobulin amyloidosis, beta-2-microglobulin amyloidosis, hemodialysis, HD, continuous ambulatory peritoneal dialysis, CAPD, near end-stage renal disease, carpal tunnel syndrome, flexor tenosynovitis, trigger finger, trigger thumb, scapulohumeral arthropathy, spondyloarthropathy, bone cysts, pathologic fractures, bone cysts

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Contributor Information and Disclosures

Author

Anita Basu, MD, Assistant Professor of Medicine, University of Mississippi School of Medicine; Staff Nephrologist, GV (Sonny) Montgomery Veterans Affairs Medical Center
Anita Basu, MD is a member of the following medical societies: American College of Physicians and National Kidney Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Carol A Bogdan, MD, Consulting Staff, Coastal Cancer Center, 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 and National Kidney Foundation
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Roche Honoraria Consulting

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, 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, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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