Beta-2-Microglobulin Amyloidosis Long-Term HD — ESENeph MCQ

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EasyHaemodialysisBeta-2-Microglobulin Amyloidosis Long-Term HDESENeph

A 55-year-old man with ESKD on haemodialysis for 12 years develops bilateral carpal tunnel syndrome, chronic joint pain in his shoulders, and cystic bone lesions on X-ray. Serum beta-2-microglobulin is 45 mg/L (markedly elevated). What is the underlying pathology?

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Correct answer: B — Dialysis-related amyloidosis (beta-2-microglobulin)

Long-term haemodialysis (typically >5 years) leads to accumulation of beta-2-microglobulin (B2M), a middle molecule that is poorly cleared by conventional low-flux HD. B2M polymerises into amyloid fibrils (Abeta2M) that deposit in synovium, tendons, and bone, causing carpal tunnel syndrome (earliest manifestation), destructive spondyloarthropathy, joint pain/stiffness, and cystic bone lesions. The triad of bilateral carpal tunnel + joint symptoms + bone cysts in a long-term dialysis patient is pathognomonic. High-flux HD and haemodiafiltration improve B2M clearance. Kidney transplantation halts progression (but does not reverse existing deposits).

Reference: Jadoul et al 1997 – Dialysis-Related Amyloidosis; UKKA 2019 – HD Guidelines