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肾脏病与透析肾移植杂志

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透析相关性淀粉样变

  

  • 出版日期:2020-02-28 发布日期:2020-03-19

Dialysis related amyloidosis

  • Online:2020-02-28 Published:2020-03-19

摘要: Dialysisrelated amyloidosis(DRA)is a serious complication of longterm dialysis therapy and is characterized by  deposition of amyloid fibrils,principally composed of β2microglobulin(β2MG),in the osteoarticular structures and viscera.The clinical manifestations of DRA are carpal tunnel syndrome,cystic bone damage and pathological fracture,osteoarthropathy,destructive joint disease,and systemic amyloidosis.The prevalence and severity of DRA would be lower with hemodialysistechnology.Amyloid fibrils have been shown to possess cytotoxic potentials.A nucleationdependent polymerization model could explain the mechanisms of amyloid fibril formation.A high plasma concentration of β2MG is considered as a prerequisite for developing DRA.Highflux hemodialysis,hemodiafiltration and immuno adsorption are able to removeβ2MG significantly,especially expanded hemodialysis.The use of biocompatible membranes and ultrapure dialysate can minimize or delay DRA onset.Renal transplantation is the best way to prevent DRA.

关键词: 透析相关性淀粉样变, &beta, 2-微球蛋白, 延展性透析, 肾移植

Abstract: Dialysisrelated amyloidosis(DRA)is a serious complication of longterm dialysis therapy and is characterized by  deposition of amyloid fibrils,principally composed of β2microglobulin(β2MG),in the osteoarticular structures and viscera.The clinical manifestations of DRA are carpal tunnel syndrome,cystic bone damage and pathological fracture,osteoarthropathy,destructive joint disease,and systemic amyloidosis.The prevalence and severity of DRA would be lower with hemodialysistechnology.Amyloid fibrils have been shown to possess cytotoxic potentials.A nucleationdependent polymerization model could explain the mechanisms of amyloid fibril formation.A high plasma concentration of β2MG is considered as a prerequisite for developing DRA.Highflux hemodialysis,hemodiafiltration and immuno adsorption are able to removeβ2MG significantly,especially expanded hemodialysis.The use of biocompatible membranes and ultrapure dialysate can minimize or delay DRA onset.Renal transplantation is the best way to prevent DRA.

Key words: dialysis related amyloidosis,&beta, 2-microglobulin,expanded hemodialysis,renal transplantation