Abstract
Carpal tunnel syndrome, which was first described by Paget in 1853, has been frequently found in chronic hemodialysis patients. Furthermore, amyloid protein and β2-microglobulin are considered to be implicated in the cause. There have been many reports that amyloid protein and β2-MG deposits are found not only on transverse ligaments but also on various organs in the body. By May 1987, 165 dialysis patients with this syndrome had visited our kidney center, and 187 hands had been operated on. In one of these patients bilateral tumors on the hip joints developed and tumorectomy was performed. Autopsies were performed on 29 patients that died in the course of renal failure during hemodialysis therapy, (21 with acute renal failure and 8 with chronic reral failure). At each operation or autopsy, a specimen was taken for pathological examination. Specific findings of the operated cases were staining for congo red, arteriosclerosis, membranous lipodystrophy and hyalinosis. Other findings were infiltration of inflammatory cells, hyperkeratosis of skin and an increased number of monocytes in the synovial membrane. In autopsy cases, we found positive staining for congo red and β2-MG around the arteriolae in the cardiac muscle and rectal mucosa and in the microcysts in the kidney in two cases.
The level of serum β2-MG in the patients with hemodialysis amyloidosis was not significantly higher than those without hemodialysis amyloidosis.
Because of the variety of pathological findings, further pathological and biochemical investigations will be needed.
