Dialysis-Related Beta-2m Amyloidosis Differential Diagnoses

Updated: Nov 14, 2019
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print
DDx

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

Dialysis-related amyloidosis (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 that usually affects the fourth and fifth digits. It is most commonly observed in men  of Northern European descent.

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