Amyloidosis, Beta2M (Dialysis-Related) Medication

Author: Anita Basu, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...

Updated: Jun 3, 2010

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Medication Summary
Immunosuppressive agents
Topical analgesics
Nonsteroidal anti-inflammatory agents
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Medication Summary

No medical treatment presently exists to reverse or alter the disease course. Low-dose steroids and nonsteroidal anti-inflammatory agents are symptomatic approaches in ameliorating joint pain and inflammation.

Class Summary

Used to suppress the inflammatory process.

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Prednisone (Deltasone, Sterapred, Orasone)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Used only in severe cases of joint pain and immobility.

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Triamcinolone (Aristospan Intra-articular)

Decreases inflammation by suppressing migration of PMNs and reducing capillary permeability. Decreases autoimmune reactions, possibly by suppressing key components of the immune system.

Class Summary

Penetrate deep for temporary relief of minor aches and pains of muscles and joints associated with arthritis.

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Capsaicin topical (Capzasin-P)

Derived from plants of Solanaceae family. May render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.

Class Summary

These agents have analgesic, anti-inflammatory properties and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

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Ibuprofen (Advil, Excedrin IB, Ibuprin, Motrin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Sulindac (Clinoril)

Decreases activity of cyclooxygenase and, in turn, inhibits prostaglandin synthesis. Results in decreased formation of inflammatory mediators.

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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.

Specialty Editor Board

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 Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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 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; AMAG Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching; Renal Ventures Ownership interest Other

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.

References

Drueke TB. Beta2-microglobulin and amyloidosis. Nephrol Dial Transplant. 2000;15 Suppl 1:17-24. [Medline].
Tan SY, Baillod R, Brown E, Farrington K, Soper C, Percy M, et al. Clinical, radiological and serum amyloid P component scintigraphic features of beta2-microglobulin amyloidosis associated with continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. Jun 1999;14(6):1467-71. [Medline].
Bely M, Kapp P, Szabo TS, Lakatos T, Apáthy A. Electron microscopic characteristics of beta2-microglobulin amyloid deposits in long-term haemodialysis. Ultrastruct Pathol. Nov-Dec 2005;29(6):483-91. [Medline].
Uji Y, Motomiya Y, Ando Y. A Circulating beta(2)-Microglobulin Intermediate in Hemodialysis Patients. Nephron Clin Pract. Feb 5 2009;111(3):c173-c181. [Medline].
Danesh F, Ho LT. Dialysis-related amyloidosis: history and clinical manifestations. Semin Dial. 2001 Mar-Apr;14(2):80-5. [Medline].
Kelly A, Apostle K, Sanders D, Bailey H. Musculoskeletal pain in dialysis-related amyloidosis. Can J Surg. Aug 2007;50(4):305-6. [Medline].
Yamamoto S, Kazama JJ, Maruyama H, Nishi S, Narita I, Gejyo F. Patients undergoing dialysis therapy for 30 years or more survive with serious osteoarticular disorders. Clin Nephrol. Dec 2008;70(6):496-502. [Medline].
Saito A, Gejyo F. Current clinical aspects of dialysis-related amyloidosis in chronic dialysis patients. Ther Apher Dial. Aug 2006;10(4):316-20. [Medline].
Matsuo K, Nakamoto M, Yasunaga C, Goya T, Sugimachi K. Dialysis-related amyloidosis of the tongue in long-term hemodialysis patients. Kidney Int. Sep 1997;52(3):832-8. [Medline].
Thornalley PJ. Glycation free adduct accumulation in renal disease: the new AGE. Pediatr Nephrol. Nov 2005;20(11):1515-22. [Medline].
Miyata T, Hori O, Zhang J, Yan SD, Ferran L, Iida Y, et al. The receptor for advanced glycation end products (RAGE) is a central mediator of the interaction of AGE-beta2microglobulin with human mononuclear phagocytes via an oxidant-sensitive pathway. Implications for the pathogenesis of dialysis-related amyloidosis. J Clin Invest. Sep 1 1996;98(5):1088-94. [Medline].
Kiss E, Keusch G, Zanetti M, Jung T, Schwarz A, Schocke M, et al. Dialysis-related amyloidosis revisited. AJR Am J Roentgenol. Dec 2005;185(6):1460-7. [Medline].
Lornoy W, Becaus I, Billiouw JM, Sierens L, Van Malderen P, D'Haenens P. On-line haemodiafiltration. Remarkable removal of beta2-microglobulin. Long-term clinical observations. Nephrol Dial Transplant. 2000;15 Suppl 1:49-54. [Medline].
Furuya R, Kumagai H, Takahashi M, Sano K, Hishida A. Ultrapure dialysate reduces plasma levels of beta2-microglobulin and pentosidine in hemodialysis patients. Blood Purif. 2005;23(4):311-6. [Medline].
Davankov V, Pavlova L, Tsyurupa M, Brady J, Balsamo M, Yousha E. Polymeric adsorbent for removing toxic proteins from blood of patients with kidney failure. J Chromatogr B Biomed Sci Appl. Feb 28 2000;739(1):73-80. [Medline].
Kutsuki H. beta(2)-Microglobulin-selective direct hemoperfusion column for the treatment of dialysis-related amyloidosis. Biochim Biophys Acta. Nov 10 2005;1753(1):141-5. [Medline].
Ozawa D, Yagi H, Ban T, Kameda A, Kawakami T, Naiki H, et al. Destruction of amyloid fibrils of a beta2-microglobulin fragment by laser beam irradiation. J Biol Chem. Jan 9 2009;284(2):1009-17. [Medline].
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. Oct 2003;42(4 Suppl 3):S1-201. [Medline].
Fry AC, Singh DK, Chandna SM, Farrington K. Relative importance of residual renal function and convection in determining beta-2-microglobulin levels in high-flux haemodialysis and on-line haemodiafiltration. Blood Purif. 2007;25(3):295-302. [Medline].
Balint E, Marshall CF, Sprague SM. Role of interleukin-6 in beta2-microglobulin-induced bone mineral dissolution. Kidney Int. Apr 2000;57(4):1599-607. [Medline].
Dember LM, Jaber BL. Dialysis-related amyloidosis: late finding or hidden epidemic?. Semin Dial. Mar-Apr 2006;19(2):105-9. [Medline].
Floege J, Ehlerding G. Beta-2-microglobulin-associated amyloidosis. Nephron. 1996;72(1):9-26. [Medline].
Gallo G, Kaakour M, Kuman A. Immunohistologic classification of systemic amyloidosis by fat aspiration biopsy. Amyloid, International Journal of Experimental and Clinical Investigation. 1994;1:94-9.
Garcia-Garcia M, Argiles, Gouin-Charnet A, Durfort M, Garcia-Valero J, Mourad G. Impaired lysosomal processing of beta2-microglobulin by infiltrating macrophages in dialysis amyloidosis. Kidney Int. Mar 1999;55(3):899-906. [Medline].
Gejyo F. Beta 2-microglobulin amyloid. Amyloid. Mar 2000;7(1):17-8. [Medline].
Gejyo F, Arakawa M. Beta 2-microglobulin-related amyloidosis: where do we stand?. Nephrol Dial Transplant. 1995;10(2):155-7. [Medline].
Haase M, Bellomo R, Baldwin I, Haase-Fielitz A, Fealy N, Morgera S, et al. Beta2-microglobulin removal and plasma albumin levels with high cut-off hemodialysis. Int J Artif Organs. May 2007;30(5):385-92. [Medline].
Jadoul M, Garbar C, Noel H, Sennesael J, Vanholder R, Bernaert P, et al. Histological prevalence of beta 2-microglobulin amyloidosis in hemodialysis: a prospective post-mortem study. Kidney Int. Jun 1997;51(6):1928-32. [Medline].
Jadoul M, Garbar C, Vanholder R, Sennesael J, Michel C, Robert A, et al. Prevalence of histological beta2-microglobulin amyloidosis in CAPD patients compared with hemodialysis patients. Kidney Int. Sep 1998;54(3):956-9. [Medline].
Kaplan B, Martin BM, Livoff A, Yeremenko D, Livneh A, Cohen HI. Gastrointestinal beta2microglobulin amyloidosis in hemodialysis patients: biochemical analysis of amyloid proteins in small formalin-fixed paraffin-embedded tissue specimens. Mod Pathol. Dec 2005;18(12):1610-7. [Medline].
Kay J. Beta 2-microglobulin amyloidosis in renal failure: understanding this recently recognized condition. Cleve Clin J Med. Mar 1999;66(3):145-7. [Medline].
Kay J. Review: Beta2-microglobulin amyloidosis. Int J Exp Clin Invest. 1997;4:187-211.
Kazama JJ, Maruyama H, Gejyo F. Reduction of circulating beta2-microglobulin level for the treatment of dialysis-related amyloidosis. Nephrol Dial Transplant. 2001;16 Suppl 4:31-5. Review:[Medline].
Miyata T, Ueda Y, Saito A, Kurokawa K. 'Carbonyl stress' and dialysis-related amyloidosis. Nephrol Dial Transplant. 2000;15 Suppl 1:25-8. [Medline].
Nangaku M, Miyata T, Kurokawa K. Pathogenesis and management of dialysis-related amyloid bone disease. Am J Med Sci. Jun 1999;317(6):410-5. [Medline].
Ritz E, Deppisch R, Stein G. Beta 2 microglobulin-derived amyloid in dialysis patients. Adv Exp Med Biol. 1989;260:11-8. [Medline].
Varga J, Idelson BA, Felson D, Skinner M, Cohen AS. Lack of amyloid in abdominal fat aspirates from patients undergoing long-term hemodialysis. Arch Intern Med. Aug 1987;147(8):1455-7. [Medline].