Long-term hemodialysis in a patient with primary amyloidosis, renal failure, and a vascular necrosis of the femoral heads.

A 38-year-old woman had polyarthralgia, proteinuria, and intractable diarrhea. Biopsy of the synovium, and intractable diarrhea. Biopsy of the synovium, rectal mucosa, and kidney revealed abundant deposition of amyloid, and the diagnosis of primary amyloidosis was made. The joint symptoms and diarrhea subsequently subsided, but her renal function progressively deteriorated. Maintenance hemodialysis was started 3 1/2 years later and was successfully continued for five years without major complications except for osteonecrosis of the femoral heads. Her Brescia shunt, however, failed frequently until a polytetraflouroethylene shunt was installed. Although the prognosis of primary amyloidosis and renal failure is poor, our case illustrates that persistent remission of the extrarenal symptoms can take place and that these patients can be successfully maintained by hemodialysis.