Granulomatous interstitial nephritis secondary to adalimumab therapy

Sandys, Vicki; Moloney, Bróna; Lane, Louise Marie; Qazi, Junaid; Doyle, Brendan; Barry, Maurice; Leavey, Sean F.; Conlon, Peter J.

doi:10.1093/ckj/sfx104

Cited by 13 publications

(11 citation statements)

References 9 publications

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“…It is present in between 0.5% and 0.9% of native renal biopsies [2]. There is a growing link between anti-TNF-alpha agents and de novo granulomatous disease [4,5]. Our case follows a temporal pattern between the initiation of adalimumab and significant kidney dysfunction at 18 months.…”

Section: Discussionmentioning

confidence: 71%

“…Similar to previous cases, withdrawal of the drug led to subsequent stabilization of serum creatinine. Previous cases have also used corticosteroids concomitantly with the withdrawal of the offending agent to reduce the risk of renal injury [5]. The timing of onset of GIN post introduction of adalimumab is variable but available data suggest around 10-12 months [5].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Adalimumab-Induced Granulomatous Interstitial Nephritis

Plant¹,

Ahmed²,

McHale³

et al. 2021

Cureus

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Adalimumab is a monoclonal antibody targeting tumour necrosis factor-alpha (TNF-alpha) and is used for the treatment of numerous autoimmune conditions. There is a paucity of evidence linking adalimumab with granulomatous interstitial nephritis (GIN). We describe a renal biopsy-proven case of GIN secondary to adalimumab therapy. A 52-year-old gentleman with a background of psoriatic arthropathy was referred to the nephrology department by his general practitioner with a progressive decline in renal function over 18 months after initiating adalimumab. A renal biopsy confirmed tubulointerstitial nephritis with focal aggregates of histiocytes, organized as granulomata. Screening for other GIN causing aetiology, including tuberculosis (TB) and sarcoidosis, was negative. Adalimumab was withheld, leading to a slow improvement in renal function over a course of six months. It is essential to monitor renal function when administrating anti-TNF alpha agents as they can rarely paradoxically cause autoimmune reactions such as GIN seen in our case.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

A Case of Adalimumab-Induced Granulomatous Interstitial Nephritis

Plant¹,

Ahmed²,

McHale³

et al. 2021

Cureus

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“…Anti-TNF therapy is used in diseases such as rheumatoid arthritis, ankylosing spondylitis, and inflammatory bowel disease. This therapy is known to be relatively safe, however reported side effects include infection, malignancy, and a variety of skin lesions [4]. Previous reports of Anti-TNF therapy associated with sarcoidlike granulomatosis have been reported with pulmonary, cutaneous, and interstitial nephritic involvement [4,5].…”

Section: Discussionmentioning

confidence: 99%

A case of Loeffler’s endocarditis after initiation of adalimumab

Hussain

Patel

Yin

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Tumor necrosis factor antagonists (anti-TNF) are increasingly prescribed as maintenance therapy for a variety of autoimmune conditions. Therefore, frequent monitoring and awareness of side effects are of the utmost importance. Adalimumab is known to cause peripheral eosinophilia, but there are few reports of more severe adverse events. Loeffler’s endocarditis is a rare and fatal disease characterized by eosinophilic infiltration of the endomyocardium leading to fibrosis and restrictive cardiomyopathy. Herein we describe a 72 year old female on adalimumab therapy for two years for rheumatoid arthritis presenting with Loeffler’s endocarditis. This case represents a rare case of Loeffler’s endocarditis diagnosed rapidly and without myocardial biopsy. Early intervention is crucial in the prevention of permanent fibrosis and mortality in Loeffler’s endocarditis. This case demonstrates the need for close monitoring and early recognition in patients on anti-TNF therapy.Abbreviations: tumor necrosis factor (TNF), hypereosinophilic syndrome (HES)

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“…The causes of IN vary; drug hypersensitivity reactions are the most common cause of IN[6]. Tumor necrosis factor (TNF) blockers, used in the treatment of various conditions including Crohn's Disease, have been published in various reports of drug-induced IN[7]. Treatment with TNF blockers in children may increase the risk of both malignancy and interstitial nephritis[2,7].…”

mentioning

confidence: 99%

“…In patients with CD diagnosed with interstitial nephritis, the IN can be related to the CD itself or the treatments administered [7,8].…”

mentioning

confidence: 99%

Interstitial Nephritis Presenting as Bilateral Renal Masses in a Pediatric Patient with Crohn’s Disease

Bouchard¹,

Romanos‐Sirakis

2020

jimsa

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We present the case of a teenage boy with Crohn’s disease treated with adalimumab who presented with discrete renal masses, found while undergoing evaluation for elevated creatinine and hypocalcemia. The MRI result, as well as the potential increased risk of malignancy in patients treated with TNF-blockers, both contributed to primary concerns of malignancy in this case. Pathology was consistent, however, with IN and not malignancy. The radiographic presentation of the IN in this case was very unusual, as IN can present as a striated nephrogram on imaging, but has not been described as discrete masses. We are not aware of any other cases of IN reported appearing this way on imaging.

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Granulomatous interstitial nephritis secondary to adalimumab therapy

Cited by 13 publications

References 9 publications

A Case of Adalimumab-Induced Granulomatous Interstitial Nephritis

A Case of Adalimumab-Induced Granulomatous Interstitial Nephritis

A case of Loeffler’s endocarditis after initiation of adalimumab

Interstitial Nephritis Presenting as Bilateral Renal Masses in a Pediatric Patient with Crohn’s Disease

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