Arthropathies associated with renal disease including dialysis-related amyloid.

In recent years most of the interest in musculoskeletal problems secondary to renal disease has focused on problems occurring in patients with chronic renal failure and specifically in patients on long-term hemodialysis. The musculoskeletal involvement in long-term hemodialysis may involve the joints, soft tissues, or both, and there is presently no good classification to which authors may refer when they report musculoskeletal problems in these patients. There has been intense interest in the past few years in the amyloidosis associated with long-term hemodialysis, and now, apparently, also with peritoneal dialysis. This type of amyloidosis is due to a specific type of amyloid, namely beta 2-microglobulin amyloid. Debate is ongoing about the role of both aluminum toxicity and iron deposition as cofactors affecting the location and extent of amyloid deposits. Debate is also unresolved about the role of specific dialysis membranes in lessening the incidence of dialysis-related amyloid. I review some of these areas as well as interesting new developments in localization of amyloid deposits in patients with chronic renal failure who are on hemodialysis.