Coates PTH, McDonald SP, Slavotinek JP, Thomas IC, Disney APS
Magnetic resonance imaging findings in shoulders of
long-term hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1476 1996
This abstract reports the results of MRI examination of 23 long-term
(6.8-27.8 yrs) dialysis patients with symptoms of shoulder discomfort.
Findings included thickening of the tendons of the supraspinatus and
subscapularis, to a degree related to time on dialysis (14 patients);
joint effusions (14 patients); bony lesions of intermediate signal on T1
(all patients); and humeral metaphyseal abnormalities (16 patients).
Histopathology was available on three of the thickened tendons, and all
showed beta-2 amyloid deposition. These abnormalities were felt by the
authors to be distinct and unlike other shoulder pathologies.
Comment: To my knowledge, up to now there has been no reliable
non-invasive
diagnostic test for dialysis-related periarticular amyloidosis. Not
being a radiologist, I can't really comment on the uniqueness of these
findings, but the description sounds compelling. MRI may be a sensitive
tool for the diagnosis of shoulder amyloid. This would be a lot more
exciting, of course, if we knew what to do about it, but the ability to
detect amyloidosis non-invasively can only help in the long run to
develop effective therapies.
(Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
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Am Soc Nephrol
CRF by organ system :
Joint disease, beta-2 microglobulin