Development of the Nephrotic Syndrome During Treatment of Crohn's Disease With Adalimumab

Abstract

We report a patient with Crohn's disease who presented with renal insufficiency and the nephrotic syndrome after initiating therapy with adalimumab. Renal biopsy showed stages 2 to 3 membranous glomerulonephritis, and immunostaining showed glomerular deposition of immunoglobulin G and C3. The patient's serum creatinine decreased after discontinuation of adalimumab, and treatment with prednisone and mycophenolic acid reversed his proteinuria. The pathogenesis of glomerular disease induced by antitumor necrosis factor antibodies is uncertain, and the potential roles of the generation of autoantibodies, development of antiadalimumab antibodies, and the interaction of adalimumab with glomerular tumor necrosis factor are discussed.

Double Glomerulonephritis in a Patient with Ankylosing Spondylitis Treated with Biologic Agent: Extrarticolar Involvement or Anti-Tumor Necrosis Factor Alpha Injury? A Case-Based Review

“…As discussed earlier, there are growing evidences of possible renal damage related to Anti-TNF even in the form of glomerulonephritis. In this regard only one case of membranous nephropathy associated to Adalimumab 15 was reported as well as one case of IgA nephropathy with the same drug. However, in the latter case, it is probably an exacerbation of a pre-existing nephropathy in a patient with psoriasis 16 rather than an initial glomerulonephritis due to Anti-TNF.…”

“…Moreover, renal disease should be also caused by formation of antibodies against the drug itself. 15 A limitation of this study is the absence of determination of antibodies against Anti-TNF.…”

Crohn Hastalığı ve Membranöz Glomerulonefrit Olgu Sunumu

“…In a 60-year-old male patient followed up with Crohn's disease, who developed proteinuria after adalimumab treatment, a diagnosis of membranous glomerulonephritis was established in renal biopsy. Membranous glomerulonephritis has been reported to develop due to the drug (10). Makhlogh et al, diagnosed ulcerative colitis in a 69-year-old female patient who presented with complaints bloody diarrhea, mucoid defecation, and confusion and was followed up for 7 years with the diagnosis of membranous glomerulonephritis (11).…”

A Brief Overview Of Childhood Nephrotic Syndrome: Review

“…82 Anektodal raporlarda, adalimumabın remisyon indüksiyonundaki etkinliği bildirilmiştir. 83,84 TİAZOLİDİNEDİONLAR FDA tarafından Tip 2 diabetes mellitus tedavisinde kullanılmaları onaylanmıştır. Metabolik sendromdan kaynaklanan kronik böbrek yetmezliğinde (KBY), hem diyabetik nefropati, hem de nondiyabetik glomerülosklerozda, farelerde ve insanlarda proteinüri, mikroalbuminüri, podosit hasarı ve vasküler hasarı azaltmaktadırlar.…”