1
|
Zhai L, Wang S, Xue F, Yao Y. Ultrasound findings of the sternoclavicular and shoulder joints in patients on maintenance hemodialysis. Ther Apher Dial 2024; 28:371-379. [PMID: 38084611 DOI: 10.1111/1744-9987.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Ultrasonographic examination of joints is a non-invasive method to detect and monitor Dialysis-associated amyloidosis (DRA). METHODS An ultrasonographic examination of the sternoclavicular (SC) and shoulder joints was performed in patients on maintenance hemodialysis (MHD) and those with normal renal function in the control group. The maximum distance (D) of SC, the rotator cuff thickness (RCs), and the echogenic pads (EPs) of the shoulder were evaluated. RESULTS Compared with the control group, the MHD group had a higher D of SC, a higher proportion of RCs ≥8 mm, and a higher proportion of EPs positive. Adjust for age and Kt/V, the D of SC was positively related to dialysis vintage, standardized coefficients β = 0.329, p = 0.004. A significant positive correlation existed between the D of SC and the RCs. CONCLUSION In addition to the shoulder joint, the sternoclavicular is a suitable site for ultrasonographic detection of DRA.
Collapse
Affiliation(s)
- Lin Zhai
- Department of Ultrasonography, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Siyu Wang
- Department of Nephrology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Fei Xue
- Department of Nephrology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Ying Yao
- Department of Nephrology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Tharwat S, Saleh M, Elrefaey R, Nassar MK, Nassar MK. Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2181. [PMID: 38138284 PMCID: PMC10744597 DOI: 10.3390/medicina59122181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.
Collapse
Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
| | - Marwa Saleh
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Rabab Elrefaey
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura 35516, Egypt;
| | - Mohammed Kamal Nassar
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| |
Collapse
|
3
|
Manfredi JM, Jacob S, Norton E. A one-health lens offers new perspectives on the importance of endocrine disorders in the equine athlete. J Am Vet Med Assoc 2023; 261:153-164. [PMID: 36595370 DOI: 10.2460/javma.22.11.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endocrine disorders are associated with joint pain and tendon injury in humans, but the effects in the horse are only starting to be understood. Similar patterns of clinical signs and injury appear to affect horses and humans for both orthopedic and endocrine disorders, supporting the use of a one-health approach to tackle these issues. In this Currents in One Health, we will discuss common equine endocrinopathies, current testing recommendations, dietary management, genetic predispositions, and endocrine disorders' effects on performance. Our aim is to use a one-health lens to describe current comparative research so that veterinarians can employ cutting-edge preventative, diagnostic, and therapeutic recommendations. Identified key gaps in knowledge include whether equine metabolic osteoarthritis exists, if steroid joint injections are safe in horses with endocrine disorders, and if the return to performance percentage improves with concurrent treatment of endocrine and musculoskeletal disorders. Key takeaways include that the relationship between endocrine disorders and musculoskeletal disease in the horse goes beyond laminitis to include lameness, muscle atrophy, suspensory ligament degeneration, osteochondritis dissecans, and potentially metabolic osteoarthritis. Approaches learned from human and equine comparative studies can offer insight into injury recognition and management, thus mitigating the impact of endocrine disorders on performance in both species. Readers interested in an in-depth description of current and future research involving pathophysiology, novel interventions, and multiomic approaches to identify individuals with athletic limitations induced by endocrine disorders are invited to read the companion Currents in One Health by Manfredi et al, AJVR, February 2023.
Collapse
Affiliation(s)
- Jane M Manfredi
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Sarah Jacob
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Elaine Norton
- 2Department of Animal and Comparative Biomedical Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| |
Collapse
|
4
|
Malta LMDA, Lugon JR, Santos AASMDD, Machado LM. Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls. Radiol Bras 2022; 55:293-298. [PMID: 36320376 PMCID: PMC9620849 DOI: 10.1590/0100-3984.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the knees of individuals with renal failure who are on
hemodialysis, using magnetic resonance imaging (MRI), comparing them with
those of a group of individuals with normal renal function. Materials and Methods This was a cross-sectional, observational, controlled study conducted between
August 2018 and February 2020. The cases consisted of 15 patients who had
been on hemodialysis for ≥ 5 years and did not have a quadriceps
tendon rupture. The controls consisted of 15 individuals with normal renal
function who were matched (1:1) to the cases for sex, age, and physical
activity level. The subjects in both groups underwent MRI of the right knee
only. Results The mean ages of the cases and controls were 50 ± 15 years and 49
± 14 years, respectively. The median time on hemodialysis was 11
years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin,
alkaline phosphatase, phosphorus, and creatinine were higher among the cases
than among the controls, whereas serum albumin and hemoglobin were lower
(p < 0.05 for all). The MRI study showed a
hyperintense signal in the quadriceps tendon in 11 of the cases and in three
of the controls (p = 0.009). Knee joint effusion was
observed in nine of the cases and in three of the controls
(p < 0.05). The thickness, length, and width of the
tendon did not differ between the groups. A hyperintense signal in the
tendon was not associated with the time on hemodialysis; nor with the levels
of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion Patients on chronic hemodialysis, even those without a tendon rupture, show a
hyperintense signal in the quadriceps tendon on MRI.
Collapse
|
5
|
Cheon M, Yoo J. Visualization of Dialysis-Related Amyloid Arthropathy on 18F-FDG PET-CT Scan. Diagnostics (Basel) 2022; 12:diagnostics12010113. [PMID: 35054280 PMCID: PMC8775128 DOI: 10.3390/diagnostics12010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
We report a case of dialysis-related amyloid arthropathy in a patient with end-stage renal disease. It presented in our patient as moderately increased FDG uptake in the amyloid deposition in the periarticular tissues and eroding into adjacent bones.
Collapse
|
6
|
Tang X, Wang J, Guo R, Huang S, Qiu L. Quantitative evaluation of the Achilles tendon and supraspinatus tendon in end-stage kidney disease patients: A potential tool for predicting spontaneous tendon rupture. Ther Apher Dial 2021; 26:734-742. [PMID: 34817901 DOI: 10.1111/1744-9987.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 02/05/2023]
Abstract
Many cases of spontaneous tendon rupture in end-stage kidney disease (ESKD) patients have been reported worldwide. Quantitative assessment of tendon has become an important way to improve the prognosis of patients. In the recruited healthy volunteers and ESKD patients, the thickness and shear wave velocity (SWV) of supraspinatus tendons and Achilles tendons were measured and compared among groups. Potential factors related to the tendon SWV of ESKD patients were screened in multiple linear regression. There was no significant difference in the tendon thickness and supraspinatus tendon SWV among groups. SWV of Achilles tendons in long-term dialysis ESKD patients were significantly lower than those in healthy volunteers (5.1 vs. 5.6 m/s, p < 0.01). Ca2+ , creatinine, body mass index, and genders are the significant factors related to the tendon SWV. Shear wave elastography can be used as a potential tool for predicting spontaneous tendon rupture in ESKD patients.
Collapse
Affiliation(s)
- Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Wang
- Department of Medical Ultrasound, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Santagati G, Cataldo E, Columbano V, Chatrenet A, Penna D, Pelosi E, Hachemi M, Gendrot L, Nielsen L, Cinquantini F, Saulnier P, Arena V, Boursot C, Piccoli GB. Positron Emission Tomography Can Support the Diagnosis of Dialysis-Related Amyloidosis. J Clin Med 2019; 8:jcm8091494. [PMID: 31546847 PMCID: PMC6781261 DOI: 10.3390/jcm8091494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/31/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The improvements in dialysis have not eliminated long-term problems, including dialysis-related amyloidosis (DRA), caused by Beta-2 microglobulin deposition. Several types of scintigraphy have been tested to detect DRA, none entered the clinical practice. Aim of the study was to assess the potential of PET-FDG scan in the diagnosis of DRA. METHODS Forty-six dialysis patients with at least one PET scan (72 scans) were selected out 162 patients treated in 2016-2018. Subjective global assessment (SGA), malnutrition inflammation score (A), Charlson Comorbidity Index (CCI), were assessed at time of scan; 218 age-matched cases with normal kidney function were selected as controls. PET scans were read in duplicate. Carpal tunnel syndrome was considered a proxy for DRA. A composite "amyloid score" score considered each dialysis year = 1 point; carpal tunnel-DRA = 5 points per site. Logistic regression, ROC curves and a prediction model were built. RESULTS The prevalence of positive PET was 43.5% in dialysis, 5% in controls (p < 0.0001). PET was positive in 14/15 (93.3%) scans in patients with carpal tunnel. PET sensitivity for detecting DRA was 95% (specificity 64%). Carpal tunnel was related to dialysis vintage and MIS. A positive PET scan was significantly associated with dialysis vintage, MIS and amyloid score. A prediction model to explain PET positivity combined clinical score and MIS, allowing for an AUC of 0.906 (CI: 0.813-0.962; p < 0.001). CONCLUSIONS PET-FDG may identify DRA, and may be useful in detecting cases in which inflammation favours B2M deposition. This finding, needing large-scale confirmation, could open new perspectives in the study of DRA.
Collapse
Affiliation(s)
| | | | | | | | - Daniele Penna
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Ettore Pelosi
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Mammar Hachemi
- Medecine Nucleaire, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | | | - Louise Nielsen
- Néphrologie, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | | | | | - Vincenzo Arena
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Charles Boursot
- Medecine Nucleaire, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | - Giorgina Barbara Piccoli
- Néphrologie, Centre Hospitalier du Mans, 72037 Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy.
| |
Collapse
|