DRA Carpal Tunnel Beta2M — ESENeph MCQ

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ModerateHaemodialysisDRA Carpal Tunnel Beta2MESENeph

A 60-year-old man on haemodialysis develops progressive bilateral carpal tunnel syndrome over 3 years. He has been on dialysis for 12 years. X-rays show subchondral cysts in the wrist. What is the underlying pathology?

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Correct answer: A — Dialysis-related beta-2 microglobulin amyloidosis

Progressive bilateral carpal tunnel syndrome in a long-term dialysis patient with subchondral bone cysts is the classic presentation of dialysis-related amyloidosis (DRA) from beta-2 microglobulin accumulation. Beta-2 microglobulin is poorly cleared by conventional haemodialysis. It deposits as amyloid fibrils in periarticular structures, tendons, and bones. High-flux dialysis and haemodiafiltration improve clearance. Kidney transplantation halts progression and allows regression. Surgical carpal tunnel release may provide symptomatic relief.

Reference: ERA-EDTA 2019 – DRA; KDOQI 2015 – HD Adequacy