Dialysis-related amyloidosis.

Dialysis-related amyloidosis (DRA) is a complication of long-term dialysis and can also be seen in patients with chronical renal failure and on continuous ambulatory peritoneal dyalisis. This review focuses on the chemical modifications of beta(2)-microglobulin that lead to the formation and deposition of beta(2)-amyloid fibrils in periarticular and articular sites which ultimately results in the clinical and radiographic characteristics of this devastating disease. Its most common manifestations are carpal tunnel syndrome, shoulder pain and destructive arthropathy. Treatment of DRA has been directed towards achieving normal serum levels of beta(2)M in end stage renal disease (ESRD) patients which usually results in clinical improvement and delay in disease progression. Medical treatment consists of the use of corticosteroids and nonsteroidal anti-inflammatory drugs. Surgical intervention for carpal tunnel syndrome or spinal cord compression can greatly improve quality of life.