Rapidly Progressive Glomerulonephritis in a Patient with Rheumatoid Arthritis during Treatment with High-Dosage <i>D</i>-Penicillamine

Abstract

A patient with advanced rheumatoid arthritis and severe clinical manifestations of rheumatoid vasculitis died of acute renal failure after 30 months of treatment with high-dosage D-penicillamine. She had had no signs of adverse drug reactions until the terminal illness. Although streptococcal pharyngitis was diagnosed late in her disease, penicillamine-induced immune complex glomerular damage is considered more likely than poststreptococcal glomerulonephritis, because her microscopic hematuria preceded diagnosis of pharyngitis. Postmortem examination disclosed findings suggestive of rapidly progressive glomerulonephritis of immune complex pathogenesis. The short period of microscopic hematuria and the rapidity of development of renal failure before death emphasize the need for frequent monitoring of renal function and prompt discontinuation of D-penicillamine treatment upon detection of otherwise unexplained hematuria. There is urgent need for early immunological evaluation, renal biopsy, and vigorous therapeutic measures.

Penicillamine-lnduced Rapidly Progressive Glomerulonephritis in a Patient with Rheumatoid Arthritis

“…We agree with Sadjadi et al [12] that the development of otherwise unexplained hematuria in a patient receiving D-penicillamine should warn of a possible RPGN and that the drug must be discontinued.…”

“…Although it has generally been asso ciated with an immune complex glomerulonephritis [12], some other authors reported cases that argue against an immune complex disease [6,13].…”

Progressive Subretinal Fibrosis in Patients with Rheumatoid Arthritis and Renal Dysfunction

“…Rapidly progressive glomerulonephritis has been reported to occur in patients with rheumatoid arthritis taking D-penicillamine or bucillamine [40][41][42][43][44][45]. The first patient in this study showed a causal relationship of bucillamine with the earlier development of nephrotic syndrome [46] but did not take it before the later onset of rapidly progressive glomerulonephritis.…”

Goodpasture’s Syndrome in a Patient Receiving Penicillamine and Carbimazole

“…More recently 2 cases of crescentic extracapillary glomerulonephritis without clinical pulmonary affecta tion have been reported during treatment with a high dose of penicillamine [15,16]. However, postmortem his tological examination showed diffuse hemorrhagic pneumonia in 1 case [16].…”