Question
A 65-year-old male with chronic renal failure presents with the complaint of shoulder pain and numbness of his right hand. The shoulder pain is bilateral and localized to the anterolateral aspect. He states he is unable to hold objects for a long time from his right hand because of numbness. The patient has been on maintenance hemodialysis for the past 20 years. On physical examination, there is atrophy of the thenar muscles of the right hand. There is decreased sensation in his right thumb, middle, index, and ring fingers. Which of the following is responsible for the patient’s current condition?
| A. |
Accumulation of serum amyloid protein
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| B. |
Hyperkalemia
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| C. |
Accumulation of beta-2 microglobulin
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| D. |
Decreased uric acid excretion
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Show Answer
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Correct Answer � C
Explanation
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Answer : C Accumulation of beta-2 microglobulin
The patient has dialysis-related amyloidosis. It is a condition in which there is the accumulation of beta-2 microglobulin.
Beta-2 microglobulin aggregates into amyloid fibers and deposits in the joint spaces in patients on long-term hemodialysis.
The treatment of systemic amyloidosis involves supportive therapy aiming to maintain the quality of life and prevent organ dysfunction.
Renal failure in a patient undergoing long-term hemodialysis can cause amyloidosis from the accumulation of light chains of the HLA 1 complex, which is normally filtered out by the kidneys. Senile amyloidosis from the deposition of transthyretin, mainly in the heart, is found in 10% to 36% of people over 80.
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