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Dialysis-Related Amyloidosis — ESENeph MCQ

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ModerateHaemodialysisDialysis-Related AmyloidosisESENeph

A 60-year-old woman with CKD G5D on haemodialysis develops beta-2 microglobulin amyloidosis. She has carpal tunnel syndrome, bone cysts, and shoulder pain. She has been on dialysis for 15 years using high-flux dialysers. What is the underlying pathogenesis?

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Correct answer: E — Accumulation of beta-2 microglobulin due to inadequate clearance by dialysis

Dialysis-related amyloidosis (DRA) is caused by the accumulation of beta-2 microglobulin (molecular weight 11.8 kDa), which is poorly cleared by conventional haemodialysis. Over years, it deposits as amyloid fibrils in joints, bone, and carpal tunnel, causing carpal tunnel syndrome, bone cysts (especially in the wrist and hip), and destructive arthropathy. High-flux and haemodiafiltration improve beta-2 microglobulin clearance. Kidney transplantation (which restores renal clearance) is the definitive treatment.

Reference: ERA-EDTA 2019 – Dialysis-Related Amyloidosis; KDOQI 2015