Nephrotic Syndrome after Oral Gold

Abstract

Auranofin Nephrotic syndromeSeronegative polyarthritis refractory to non-steroidal anti-Inflammatory drugs developed in a 66-year-old woman with a history of allergy to penicillin . Auranofin 6 mg/day and methylprednisolone 4 mg/day were instituted and indomethacin therapy was continued After 8 weeks of treatment her symptoms had resolved but red and white blood cells were recovered in a urine sample . IndomethaCin was discontinued but 3 weeks later a maculopapular rash and peripheral oedema developed. Auranofin was also withdrawn. At this time laboratory results included proteinuria 8.4 gjday, creatinine clearance 111 ml j min, serum albumin 25 gjL and negative antinuclear factor and HLA-DR3. A renal biopsy revealed membranous glomerulonephritis . The patient improved after 16 weeks of corticosteroid therapy.Nephrotic syndrome after auranofin is unusual. This is possibly a result of lower serum and renal gold concentrations , compared with those associated with parenteral gold .