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D Sethi

Publications and source records attributed to D Sethi.

34 records · Page 2Linked to original sources
PubMed1990

Dialysis arthropathy: a clinical, biochemical, radiological and histological study of 36 patients.

Out of a population of 97 haemodialysis patients, 36 patients with dialysis arthropathy were identified. Dialysis arthropathy is a chronic symmetrical polyarthritis which affected 97 per cent of the patients who had been undergoing cuprophane haemodialysis for more than 10 years. It commonly affected the shoulders, hips, hands, knees and wrists, worsening with time and extending to other joints. Fifty-eight per cent of the patients complained of morning stiffness and 47 per cent complained of exacerbation of shoulder pain during or after haemodialysis. Half of the patients also suffered from carpal tunnel syndrome, which recurred and was associated with a long-lasting disability. The most common radiological abnormality was periarticular bone cysts, followed by articular erosions and a destructive spondyloarthropathy, but clinical symptoms were more common than radiological signs. Patients with dialysis arthropathy had a higher C-reactive protein level than patients without arthropathy (18.6 mg/l versus 11.4 mg/l), indicative of an inflammatory process. Some of the clinical manifestations of the disease correlated with levels of C-reactive protein and ferritin. Serum ferritin levels correlated strongly with the units of blood transfused in the past five years (RS = 0.83), and the logarithm of ferritin level correlated weakly with C-reactive protein (r = 0.32). Haemarthroses were documented in 19 per cent of patients. Mean serum beta 2-microglobulin was elevated in the patients with (57.3 mg/l) and without arthropathy (50.7 mg/l), and there was no difference in the parathormone or aluminium levels between these groups. Articular tissue was obtained in 25 patients; beta 2-microglobulin amyloid was present in 24. Larger deposits were present in the capsular tissue, and these appeared to replace collagen bundles in eight cases. Amyloid deposits replaced the lining layer in six cases. It is likely therefore that amyloid disrupts normal joint function by replacing normal joint tissue. Mild chronic synovitis with haemosiderin deposition were found in approximately 60 per cent of cases. These findings suggest that amyloid derived from beta 2-microglobulin has a primary role in the pathogenesis of dialysis arthropathy, but there was also evidence of inflammatory processes. It is suggested that iron overload or haemarthroses might contribute to the inflammation, but other factors, such as dialysis-related bioincompatibility reactions, may also have a role.

Adult↗
PubMed1990

Technetium-99-labelled methylene diphosphonate uptake scans in patients with dialysis arthropathy.

Patients on long-term haemodialysis suffer from dialysis arthropathy due to the deposition of dialysis amyloid. We investigated the use of 99Tc-labelled methylene diphosphonate bone scans in 17 patients as a possible in vivo diagnostic technique. In most clinically affected joints, with the exception of shoulders and hands, there was increased radioisotope uptake consistent with uptake by periarticular bone. In addition, we describe intense soft-tissue uptake around some clinically affected large joints. In contrast, control groups of patients on haemodialysis without arthropathy and patients without renal failure did not have increased uptake. A semi-quantitative scale of uptake was devised, and the following correlations were significant: pain perception and isotope uptake score in the ankles and feet, and the number of radiological lesions and isotope uptake scores in the wrists and knees. The following sites where the radioisotope might bind in the affected joints are proposed: amyloid deposits, areas of soft-tissue calcification, or areas of increased bone turnover. It is concluded that whereas the scanning technique cannot make a definite diagnosis of amyloid and, therefore, cannot be expected to supersede histological diagnosis, it is a useful adjuvant investigation, of particular importance in those patients unable or unwilling to undergo biopsy.

Adult↗
PubMed1990

Macroglossia and amyloidoma of the buttock: evidence of systemic involvement in dialysis amyloid.

A 48-year-old male on cuprophane haemodialysis for 18 years, with a history of dialysis arthropathy and recurrent carpal tunnel syndrome developed macroglossia and bilateral buttock tumoral masses. The tongue and buttock masses were biopsied. Histology of both biopsies showed amyloid deposits of the beta 2-microglobulin (B2M) variety. Amyloidomas in the gluteal region and macroglossia have not been previously described in amyloid derived from B2M. These findings suggest that systemic B2M amyloidosis can have a similar tissue distribution to AL amyloidosis. This case also stresses the importance of inspection of the tongue, and palpation of the gluteal region for masses, in the assessment of patients with dialysis arthropathy.

Amyloid↗
PubMed1989

Acute metabolic alkalosis during haemodialysis.

A 32-year-old woman developed acute metabolic alkalosis during haemodialysis due to dialysate with a very high bicarbonate concentration. This was subsequently discovered to have been caused by the reversed connection of bicarbonate and acid concentrate containers to the entry ports of the Monitral 'S' machine and to failure of the pH meter. Recommendations are made to prevent this potentially fatal accident.

Acute Disease↗
PubMed1989

Clearance of beta-2-microglobulin using continuous ambulatory peritoneal dialysis.

In the 9 continuous ambulatory peritoneal dialysis (CAPD) patients studied, the mean clearance of beta 2-microglobulin was significantly higher using hypertonic as opposed to isotonic exchanges (1 ml/min and 0.75 ml/min, respectively). Clearance of beta 2-microglobulin correlated with the clearance of albumin. The daily mass transfer of beta 2-microglobulin ranged from 19 to 62 mg. Although all the daily production of beta 2-microglobulin is not eliminated in patients on CAPD their serum beta 2-microglobulin levels would be expected to be lower than in patients on haemodialysis. Long-term prospective studies are needed to determine whether lower serum beta 2-microglobulin levels lead to a lower incidence of dialysis amyloid.

Ascitic Fluid↗
PubMed1989

Dialysis-associated amyloid: systemic or local?

Dialysis-associated amyloidosis has been classified as one of the local amyloidoses. To test this, we examined post-mortem tissue from 14 long-term haemodialysis patients, ten with dialysis arthropathy and four without arthropathy. Tissue was obtained from the shoulder, knee, or hip joints and the following organs: brain, kidney, liver, heart, lung, spleen, and rectum. Congo-red stain was used to identify amyloid deposits and these were characterised further using an indirect immunoperoxidase technique with antibodies to beta 2-M, prealbumin, serum amyloid A protein, and kappa and lambda light chains. All patients with arthropathy had large deposits of beta 2-M amyloid in the articular tissues. In contrast to this, systemic amyloid deposits were only found in four patients and were small and mainly confined to vessel walls. The four patients without joint symptoms had no evidence of systemic or articular amyloidosis. In addition, subcutaneous fat aspirations were carried out in 13 patients with dialysis arthropathy and 12 without arthropathy. Amyloid deposits were only found in two patients with arthropathy. Our results show that dialysis-associated amyloidosis has a predilection for deposition in articular tissues, and that systemic deposits are infrequent, small, and mainly confined to vessel walls. The discrepancy between our post-mortem series and case reports describing large systemic deposits may be due to differences in patient susceptibility.

Adipose Tissue↗
PubMed1988

C-reactive protein in haemodialysis patients with dialysis arthropathy.

Increased plasma C-reactive protein was found in one-third of 99 patients on maintenance haemodialysis and there was a significant correlation between C-reactive protein and years on haemodialysis. Patients with dialysis arthropathy had a significantly higher mean C-reactive protein than the patients with no joint symptoms. Our results suggest that chronic inflammatory reactions occur in long-term haemodialysis patients and that dialysis arthropathy may have an inflammatory basis.

C-Reactive Protein↗
PubMed1988

Dialysis arthropathy, beta 2-microglobulin and the effect of dialyser membrane.

Patients with dialysis arthropathy had the greatest mean serum beta 2-microglobulin (59.5 mg/l) but there was no threshold concentration of beta 2-microglobulin above which all patients developed dialysis arthropathy. Haemodialysis patients without dialysis arthropathy and patients on continuous ambulatory peritoneal dialysis (CAPD) also had grossly elevated values of beta 2-microglobulin (47.9 mg/l and 30.7 mg/l respectively). There was a significant positive correlation between duration of treatment and serum beta 2-microglobulin for the patients treated by haemodialysis, but this was not the case for patients on CAPD. There was a significant negative correlation between residual urinary volume and serum beta 2-microglobulin for the patients on haemodialysis without dialysis arthropathy, and also for the patients on CAPD. This was not true for the patients with dialysis arthropathy. Both duration of treatment and residual urine volume correlated with serum beta 2-microglobulin, and therefore an analysis of covariance was used to take account of this in comparing the groups. This showed that there was no difference between serum beta 2-microglobulin in haemodialysis patients with and without dialysis arthropathy. However, CAPD patients had a significantly lower corrected mean serum beta 2-microglobulin. Haemodialysis with cuprophane membranes was associated with an increase in beta 2-microglobulin of 11.5%, whereas haemodialysis with polycarbonate was associated with a decrease of 6.8% at 6 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis↗
PubMed1986

Dialysis arthropathy: amyloid or iron?

The clinical, biochemical, radiological, and pathological features in five cases of dialysis arthropathy were analysed. All patients were receiving long term haemodialysis and had had multiple blood transfusions. The arthropathy affected both large and small joints, was predominantly bilateral, and in all cases was associated with the carpal tunnel syndrome. In some instances joint pain was exacerbated during dialysis. In four cases the serum ferritin concentration was raised. Radiological examination showed a few juxta-articular cysts and erosions but most affected joints looked normal. All synovial tissue examined showed amyloid, which stained immunohistochemically for beta 2 microglobulin. Large amounts of iron were present in synovial tissue from affected joints. It is suggested that the deposits of iron, rather than amyloid, in synovial tissue may be the cause of the arthropathy. Iron may be derived locally as a result of haemarthrosis or it may be a manifestation of systemic iron overload.

Adult↗