SYSTEMIC DISTRIBUTION OF BETA(2)-MICROGLOBULIN-DERIVED AMYLOIDOSIS INPATIENTS WHO UNDERGO LONG-TERM HEMODIALYSIS - REPORT OF 7 CASES AND REVIEW OF THE LITERATURE

A search for visceral amyloid deposits was performed on autopsy materi al from 20 patients who had been receiving long-term hemodialysis trea tment for 4 to 21 years. Visceral amyloid was found in seven patients who had undergone hemodialysis for more than 10 years. Histochemically , the amyloid was permanganate sensitive, and immunohistochemically, i t stained positively for beta(2)-microglobulin. The amyloid was found mainly in the wall of blood vessels, in the form of subendothelial nod ules, bulging into the vessel's lumen. The amount of amyloid increased with increasing years of hemodialysis treatment. The organs most freq uently involved were the heart, gastrointestinal tract, and lungs. Sma ller deposits were seen in medium blood vessels of all other visceral organs. Only the spleen was ''resistant'' to amyloid deposition; the r eason for this splenic resistance is unknown. A similar organ distribu tion was found in the 19 previously reported autopsy cases. Clinically , one patient experienced a perforation of the small intestine, probab ly related to the narrowing of the intestinal blood vessels by amyloid deposits, and this patient died of peritonitis.