Renal involvement in rheumatoid arthritis: analysis of renal biopsy specimens from 100 patients

Abstract

We analyzed renal biopsy specimens from 100 patients to evaluate the characteristics of renal involvement in patients with rheumatoid arthritis (RA). Membranous nephropathy (MN) was the most common renal histological pattern (31%). Mesangial proliferative glomerulonephritis (GN) was found in 21% of cases (IgA nephropathy 12%, non-IgA GN 9%), minor changes in 17%, renal amyloidosis in 11%, interstitial nephritis in 9%, sclerotic GN in 4%, and crescentic GN in 2%. MN was relatively more frequent in men than in women, and most developed nephrotic syndrome, while a few developed renal failure. Disease-modifying antirheumatic drugs (DMARDs) correlated with MN in 26 of 31 cases. Mesangial proliferative GN showed high-grade hematuria. Amyloidosis correlated with long duration of RA; approximately half of the cases with amyloidosis also had nephrotic syndrome, and 82% developed renal failure. Of the 100 patients, 82% showed some tubulo-interstitial changes, which might be related to non-steroidal anti-inflammatory drugs. Because renal lesions in RA are very diverse, and early stage cases of MN and amyloidosis can be detected only by histological examinations, renal biopsy should be performed in cases with continuous urinary abnormalities or progressive renal failure.

Mediterranean fever gene mutations in patients with idiopathic mesangial proliferative glomerulonephritis

“…IgA nephropathy is the prototype of MePGN. Secondary MePGN is documented in a variety of disorders, such as systemic lupus erythematosus, Henoch-Schönlein purpura, rheumatoid arthritis, and vasculitic syndromes (27)(28)(29). Therapeutic response to corticosteroid and colchicine has been reported in a few patients with MePGN who harbored heterozygous MEFV gene mutations (3,4,24,26).…”

MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature

“…Makino et al reported the results of renal biopsies in 100 patients with RA. These patients had a great heterogeneity of renal lesions, and the most frequent finding was membranous nephropathy (n = 31) and only 6 of these cases were considered not related to DMARDs (3). Renal amyloidosis was detected in 11 patients and only 2 patients had crescentic GN.…”

“…Another relevant aspect in this case is the absence of amyloid deposits in kidney, even after, approximately, 30 years since the diagnosis of RA. The incidence of renal amyloidosis in patients with RA varies from 11% to 30%(1,3) and is associated with poor renal outcome(3). …”

Membranous Nephropathy Associated with the Relatively Selective Cyclooxygenase-2 Inhibitor, Etodolac, in a Patient with Early Rheumatoid Arthritis

“…Renal dysfunction and urinary abnormalities, which are usually related to drug toxicity, secondary amyloidosis, or those which overlap with other autoimmune conditions, are frequently observed in patients with rheumatoid arthritis (1). Membranous nephropathy is well-known to occur in rheumatoid arthritis patients treated with gold salt, Dpenicillamine or bucillamine (1)(2)(3). Here, we describe a patient with short-duration rheumatoid arthritis who presented with membranous nephropathy associated with the relatively selective cyclooxygenase-2 inhibitor, etodolac (4).…”