Dialysis arthropathy: identification and evaluation of a subset of patients with unexplained inflammatory effusions.

Abstract

Rheumatic disorders have been reported in patients with chronic renal failure treated with hemodialysis. We identified and evaluated 9 patients undergoing hemodialysis with inflammatory joint effusions not explained by known causes such as gout and bacterial infection. Forty-nine consecutive synovial fluid (SF) analyses on 41 dialysis patients were reviewed. Nine with unexplained inflammatory arthritis were studied in detail. SF analysis included polarized light examination, alizarin red S stain, Congo red stain, cultures, transmission electron microscopy, and electron probe elemental analysis. SF leukocyte counts ranged from 4550 to 36,000/mm3 with 44-98% neutrophils. No infections were identifiable in these patients. Findings evaluated as possible factors in the joint inflammation included apatite crystals, iron, lipids, amyloid, and difficult to diagnose nonbacterial infections such as hepatitis C. Some highly inflammatory joint effusions in patients undergoing chronic hemodialysis are not due to pyogenic infections and may be attributable to other factors.