Jadoul M
Department of Nephrology, Cliniques Universitaires St. Luc, University of Louvain Medical School, Brussels, Belgium.
Nephrol Dial Transplant. 1998;13 Suppl 7:61-4. doi: 10.1093/ndt/13.suppl_7.61.
The histological prevalence of dialysis-related amyloidosis (DRA) is much greater than suspected on clinical grounds: one-third of patients are affected after less than 4 years on haemodialysis (HD) and over 90% after more than 7 years HD. Risk factors include the time on dialysis, the type of HD membrane, and the age of the patient at onset of dialysis. The protective effect of high-flux membranes such as AN69 probably results mainly from the greater clearance of beta2-microglobulin. Other potential but more controversial explanations include a protective influence on residual renal function, a lower stimulation of beta2-microglobulin synthesis or release, or a beneficial influence on advanced glycosylation end (AGE) products. The higher risk of DRA in older patients has recently been suggested to result from an age-related AGE-modification of osteoarticular collagen. The best prevention and treatment of DRA is successful renal transplantation. In patients unsuitable for transplantation, high flux membranes such as AN69 should be used from the start of dialysis. Palliative treatment includes analgesics, low dose prednisone in severe cases, and surgical treatment of complications.
透析相关性淀粉样变性（DRA）的组织学患病率远高于临床推测：血液透析（HD）不足4年的患者中有三分之一受其影响，HD超过7年的患者中超过90%受其影响。危险因素包括透析时间、HD膜的类型以及患者开始透析时的年龄。诸如AN69等高通量膜的保护作用可能主要源于其对β2微球蛋白的清除率更高。其他潜在但更具争议的解释包括对残余肾功能的保护作用、对β2微球蛋白合成或释放的较低刺激，或对晚期糖基化终末（AGE）产物的有益影响。最近有人提出老年患者发生DRA的风险较高是由于与年龄相关的骨关节胶原的AGE修饰。DRA的最佳预防和治疗方法是成功进行肾移植。对于不适合移植的患者，应从透析开始就使用诸如AN69等高通量膜。姑息治疗包括使用镇痛药、严重病例使用低剂量泼尼松以及对并发症进行手术治疗。
