Ultrasound diagnostics of the dialysis-related amyloidosis

Abstract

Dialysis-related amyloidosis (DRA) is a serious complication arising in the context of long-term hemodialysis or continuous ambulatory peritoneal dialysis. DRA predominantly involves the osteoarticular system and is clinically manifested by erosive and destructive osteoarthropathies and carpal tunnel syndrome. The aim of this study was to establish distinguishing features of the DRA in dialysis patients by using ultrasound. Joints and soft tissues of 200 patients with chronic kidney disease receiving dialysis were studied by ultrasound. Fourteen patients (7,0%) had clinically and radiologically evident, biopsy proven DRA. In this group of patients, all patients were receiving hemodialysisfor an average of 168 months. There was positive correlation found between dialysis duration and presence of DRA (Rs = 0,667; p < 0,001). The relationship between presence of DRA and discovered joints changes using ultrasound is analyzed. More frequent involvement in the pathological process shoulder (92,9%) and hip joints (64,3%) was noted. There were statistically significant differences in rotator cuff thickness and hip joint anterior synovial space thickness in patients with DRA compare to general group (p < 0,001). Ultrasound is a highly informative method of diagnosing DRA in patients with end-stage renal disease. It provides detailed soft tissue and joint description substituting other imaging modalities.