A Half-Century Dialysis Survivor: Clinical and Autopsy Findings

Noto Okubo; Tatsuya Suwabe; Yuki Oba; Daisuke Ikuma; Hiroki Mizuno; Akinari Sekine; Eiko Hasegawa; Masayuki Yamanouchi; Junichi Hoshino; Izuru Kitajima; Masanori Shiba; Koki Uruga; Fuji Takeshi; Kenichi Ohashi; Naoki Sawa; Yoshifumi Ubara

doi:10.1016/j.xkme.2023.100612

A Half-Century Dialysis Survivor: Clinical and Autopsy Findings

Kidney Med. 2023 Feb 7;5(4):100612. doi: 10.1016/j.xkme.2023.100612. eCollection 2023 Apr.

Authors

Noto Okubo¹, Tatsuya Suwabe¹, Yuki Oba¹, Daisuke Ikuma¹, Hiroki Mizuno¹, Akinari Sekine¹, Eiko Hasegawa¹, Masayuki Yamanouchi¹, Junichi Hoshino¹, Izuru Kitajima², Masanori Shiba³, Koki Uruga⁴, Fuji Takeshi⁴, Kenichi Ohashi^{4

5}, Naoki Sawa¹, Yoshifumi Ubara¹

Affiliations

¹ Nephrology Center and Okinawa Memorial Institute for Medical Research, Toranomon Hospital, Kajigaya, Japan.
² Department of Orthopedic Surgery, Toranomon Hospital, Tokyo, Japan.
³ Department of Cardiovascular Medicine, Toranomon Hospital, Tokyo, Japan.
⁴ Department of Pathology, Toranomon Hospital, Tokyo, Japan.
⁵ Department of Human Pathology, Tokyo Medical Dental University, Tokyo, Japan.

Abstract

A man in his 20s initiated intermittent peritoneal dialysis in the late 1960s. He subsequently transitioned to hemodialysis and survived for more than 50 years, spanning low-flux and high-flux hemodialysis eras. He underwent surgery for cervical and lumbar spinal canal stenosis after 30 and 35 years, respectively, and both surgeries revealed similar degrees of severe amyloid deposition. At autopsy, significant improvement was seen in lumbar amyloid deposition. During the previous 25 years, serum β2 microglobulin levels had decreased from 40 mg/L and been maintained at 20 mg/L. This case indicates that advances in dialysis therapy aimed at lowering β2 microglobulin concentrations have reduced highly deposited amyloid.

Keywords: Dialysis-related amyloidosis; hemodialysis; intermittent peritoneal dialysis.

Publication types

Case Reports