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Kidney Week

Abstract: PO0906

Reverse Shoulder Arthroplasty in Dialysis Amyloidosis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Schilling, Jessica, University of Kentucky College of Medicine, Lexington, Kentucky, United States
  • Kamineni, Srinath, University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Richards, Dana, University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Faugere, Marie-Claude M., University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Lima, Florence, University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Sawaya, B. Peter Emile, University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Rao, Madhumathi, University of Kentucky Medical Center, Lexington, Kentucky, United States
Introduction

The use of high-flux over cuprophane dialyzers, has led to Beta-2 microglobulin amyloidosis (B2M) becoming rare in long term hemodialysis (HD) patients. Amyloid fibers embed systemically, skeletal involvement producing bone cysts, tendinopathy and fractures.

Case Description

A 65-yo male on chronic HD for 30 years presented with progressive, right (R) shoulder intractable pain and limited range of movement (ROM). X-ray/MRI identified severe glenohumeral osteoarthritis (OA), tendinopathy and large irreparable rotator cuff tear. Past history included heart failure, pulmonary hypertension, hepatitis C, severe secondary hyperparathyroidism and chronic anemia. Surgical history included bilateral (b/l) total hip arthroplasties, b/l carpal tunnel release, R nephrectomy for renal cell carcinoma in renal cystic disease.
Due to the intractable pain, disability and failure of physical therapy and corticosteroid injection therapy he underwent reverse shoulder arthroplasty. Operative findings showed large soft tissue deposits about the subscapularis, glenoid and labrum, attributed to amyloid. Histology of intra-articular soft tissue, labrum and synovium confirmed amyloid (apple-green birefringence by Congo Red Staining) with focal calcium pyrophosphate deposition. Undecalcified histology of humeral head showed moderate secondary hyper-parathyroid bone disease with peri-trabecular amyloid deposits. Following surgery patient noted marked improvement in pain and partial improvement in shoulder ROM.

Discussion

No treatment exists for HD patients with B2M, ineligible for kidney transplant. Physicians are tasked with treating clinical manifestations that severely impact quality of life (QOL). Concern for adverse outcomes and paucity of surgical precedent should not deter appropriate surgical intervention. This patient illustrates the clinical and surgical decision-making targeted to improving (QOL).