A diabetic patient is undergoing dialysis. Aspiration done around the knee joint would show -
Ans. is 'a' i.e., A-b2 Microglobulin Hemodialysis associated amyloidosiso Patients on long term hemodialysis for renal failure develop amyloidosis owing to deposition of b2-microglubin.o In patiens with renal failure, b2- migroglobulin is present in high concentration, but it cannot be filtered through the dialysis membranes and is retained in circulation,o Hemodialysis associated amyloid deposits in the synovium, joints, and tendon sheaths.Classification of amyloidosiso The amyloid can be classified in to following two broad groups -1. Systemic i generalised) amyloidosisWhen amyloidosis affects more than one body organ or system.On clinical grounds, the systemic (generalised) amyloidosis is subclassified into -Primaryo Primary' amyloidosis occurs when a specialized cell in the bone marrowr (plasma cell) spontaneously produce a particular portion, (i.e. light chain) of antibody - AL (amyloid light chain).o It is the most common type of amyloidosis.Secondary (Reactive)o When amyloidosis occurs as a result of underlying chronic inflammatory process, i.e. AA type,o Other systemic amyloidoses do not fall in either of these categories.Important Systemic amyloidosisAmyloid proteinProcursorSyndrome or involved tissueALImmunoglobulin light chainPrimary, Myeloma associatedAASerum AA (SAA)Reactive, chronic inflammatoty conditionAb2mb2 microglobulinHemodialysisAASAAFamilial mediterranean feverATTRTransthyretinFamilial amyloidotic polyneuropathiesATTRTransthyretinSystemic senile AmyloidosisNote - In AL amyloidosis, most of the time, light chain is lambda ('l'). In some cases it is Kappa (k).2. Localized (organ-specific amyloidosis)o when deposits are limited to a single organ, e.g. heart.Important Localized amyloidosisAmyloid proteinPrecursorSyndrome or involved tissueAbAbprotein precursor (AbPP)Alzheimer's diseaseAPrPPrion proteinSpongiform encephalopathyA CalCalcitoninMedullary carcinoma of thyroidAIAPPIslet amyloid polypeptideType II diabetes. InsulinomasAANFAtrial natriuretic factorIsolated atrial amyloid
A-b2 Microglobulin
AA
AL
Lactoferrin
Histo Pathology