[Dialysis amyloidosis and beta-2-microglobulin].

Basic facts are presented of the recently identified and yet clinically very significant complication of chronic artificial kidney treatment -- haemodialysis amyloidosis. The manifestations include the carpal tunnel syndrome, humeroscapular periarthritis, and other types of arthritis, destructive spondyloarthropathy, bone cysts as well as, very probably, visceral involvement. Fully developed, the disease may cause invalidism. The presence of amyloid with beta-2-microglobulin as the main component was proved in articular structures and other localizations. The precise mechanism of the build-up of this amyloid is not known, though a massive and chronic increase in beta-2-microglobulin in the blood of haemodialyzed patients is thought to be mainly responsible. Since beta-2-microglobulin is not normally removed in routine cuprophane haemodialysis, its blood values keep increasing. This phenomenon is reported to be connected with the biocompatibility of the dialysis membrane and, of late, with serum osmolality changes in the course of haemodialysis. While the highly previous membranes used for haemofiltration and haemodiafiltration do remove beta-2-microglobulin the serum levels are never completely normalized. Current research centers on the problem of whether the incidence of dialysis amyloidosis can be reduce by a wider use of on-line haemofiltration.