DIALYSIS ARTHROPATHY - IDENTIFICATION AND EVALUATION OF A SUBSET OF PATIENTS WITH UNEXPLAINED INFLAMMATORY EFFUSIONS

Objective. Rheumatic disorders have been reported in patients with chr onic renal failure treated with hemodialysis. We identified and evalua ted 9 patients undergoing hemodialysis with inflammatory joint effusio ns not explained by known causes such as gout and bacterial infection. Methods. Forty-nine consecutive synovial fluid (SF) analyses on 41 di alysis patients were reviewed. Nine with unexplained inflammatory arth ritis were studied in detail. SF analysis included polarized light exa mination, alizarin red S stain, Congo red stain, cultures, transmissio n electron microscopy, and electron probe elemental analysis. Results. SF leukocyte counts ranged from 4550 to 36,000/mm(3) with 44-98% neut rophils. No infections were identifiable in these patients. Findings e valuated as possible factors in the joint inflammation included apatit e crystals, iron, lipids, amyloid, and difficult to diagnose nonbacter ial infections such as hepatitis C. Conclusion. Some highly inflammato ry joint effusions in patients undergoing chronic hemodialysis are not due to pyogenic infections and may be attributable to other factors.