Dialysis Quiz - Dialysis Associated Amyloidosis

I was reminded by one of the readers that I hadn't provided an answer to the dialysis quiz for Nov 14, 2011. The question was:

Coronal T1-weighted MR image (TR/TE, 500/14) reconfirms erosion (arrowhead).
Large intraarticular and periarticular hypointense amyloid deposits (arrows)
Source: Kiss et al AJR 185:6, 1460-1467, 2005

A 78-year old retired African-American lawyer with ESRD secondary to diabetes mellitus, on chronic dialysis for the past 15 years presents with a history of non-specific left hip pain, worse on walking. He also relates a history of left hand numbness. His course has been uncomplicated except for a prior MI 5 years previously and s/p appendectomy and left inguinal hernia repair. Physical examination shows reduced power and sensation in the left median nerve distribution. He has difficulty in flexing and abducting at the hip. Laboratory data on monthlies: BUN 58 mg/dL , creatinine 7.8 mg/dL, K= 4.8, HC03 29, Ca/Phos 9.7/ 5.2. PTH 244, Hgb 11.5, WCC 7.8, Plats 189. What is the differential diagnosis and what radiological test would you do next?


The answer is: dialysis associated amyloidoisis. The differential diagnosis includes multiple myeloma, hyperparathyroidism with a brown tumor, and metastatic cancer. The protean causes of a mixed sensory and motor polyneuropathy should also be considered. Some useful links are here and here. The slides 1-5 provide teaching points:

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