Dialysis amyloid: the bottom line

Abstract

Case A 60-year-old lady, who had been on conventional haemodialysis for 27 years and high flux haemodialysis for 4 years, presented with bilateral buttock pain on sitting. The cause of renal failure was medullary cystic disease and she also suffered from Caroli’s disease, hepatitis C, hyperparathyroidism necessitating parathyroidectomy, and ischaemic heart disease. On examination, there were hard, indurated and tender swellings of both buttocks without lymphadenopathy. There were no masses palpable elsewhere. A computed tomography (CT) scan demonstrated ill defined high attenuation signals in both buttocks, greater on the left than the right (Figure 1). Histological analysis of a percutaneous needle biopsy of the region revealed widespread deposition of amyloid (Figure 2). Given the large size of the deposits and their proximity to critical neurological structures, she was managed conservatively with analgesics.