WIDESPREAD ALUMINUM DEPOSITION IN EXTRACEREBRAL ORGAN SYSTEMS OF PATIENTS WITH DIALYSIS-ASSOCIATED ENCEPHALOPATHY

We have described new silver-staining methods for the demonstration of lesions in senile dementia of the Alzheimer type. The same procedure was used to visualize characteristic aluminium (A1)-containing inclusi ons in choroid epithelium, glia and neurons of the central nervous sys tem in dialysis-associated encephalopathy (DAE). Here we describe the patterns and degree of A1 deposition in extracerebral tissues of 12 DA E autopsy cases. Light microscopy of silver-stained paraffin sections demonstrated autonomic ganglion cells filled with numerous intracytopl asmic black-stained fine granular inclusions, which were also seen in endocrine tissues (pituitary, parathyroid and adrenal) and in Leydig c ells. Heart, liver cells and the testicular tubules were involved, but decalcified bones, haematopoetic elements, hyperplastic epithelium an d one case of malignant epithelium lacked inclusions. Laser microprobe mass analysis revealed prominent A1-related mass signals within the e n-bloc silver-stained inclusions which were seen at low intensity in a djacent non-stained structures. Electron microscopy demonstrated accum ulations of small electron-dense granules intermingling with lipopigme nts.