Hemodialysis associated amyloidosis is caused by the deposition of the b2 microglobulin which is a component of MHC class I molecule and cannot be filtered through the cuprophane dialysis membrane. It gets deposited in the synovium, joints and the tendon sheaths. Deposition of the amyloid in long term hemodialysis takes place in joints and in the carpal ligament of the wrist, the latter leading to development of ‘carpal tunnel syndrome’
The histological examination of the biopsy material is the commonest and confirmatory method for the diagnosis in a suspected case of amyloidosis. The sites for the biopsy can be the renal tissue, rectum, abdominal fat aspiration and gingiva. The rectum is the best site for taking the biopsy in the options provided.
Transthyretin is a normal serum protein that binds and transports thyroxine and retinol (transthyretin). A mutant form of transthyretin is deposited in a group of genetically determined disorders referred to as familial amyloid polyneuropathies’.
AL (Amyloid Light chain) protein is produced by immunoglobulin secreting plasma cells and their deposition is associated with some form of monoclonal B cell proliferation. These patients have a modest increase in the number of plasma cells in the bone marrow (plasmacytosis) which presumably secrete the precursors of AL protein.
The proliferation of smooth muscle cells is a critical event in the neointimal hyperplastic response. Several studies have clearly demonstrated that blockade of smooth muscle cell proliferation resulted in preservation of normal vessel phenotype and function, causing the reduction of neointimal hyperplasia and graft failure.
WhatsApp us