RESEARCH - Development of glomerulonephritis during anti-TNF-{alpha} therapy for rheumatoid arthritis.

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Nephrol Dial Transplant. 2005 Apr 29; [Epub ahead of print] Related

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Development of glomerulonephritis during anti-TNF-{alpha} therapy for

rheumatoid arthritis.

Stokes MB, K, Markowitz GS, Ebrahimi F, Hines W, Kaufman D, B,

Wolde D, D'Agati VD.

Department of Pathology, Columbia University College of Physicians and

Surgeons, New York, NY, USA.

Background. Treatment of rheumatoid arthritis with anti-tumour necrosis

factor alpha (TNFalpha) agents may lead to autoantibody formation and flares

of vasculitis, but renal complications are rare. METHODS: We report the

clinical and pathologic findings in five patients with longstanding

rheumatoid arthritis (duration of rheumatoid arthritis, 10-30 years; mean,

23 years) who developed new onset of glomerular disease after commencing

therapy with anti-TNFalpha agents (duration of therapy, 3-30 months; median,

6 months). RESULTS: At presentation, three patients were receiving

etanercept, one adalimumab and one infliximab. Two subjects presented with

acute renal insufficiency, haematuria, nephrotic-range proteinuria, positive

lupus serologies, and hypocomplementemia, and renal biopsies showed

proliferative lupus nephritis. Two individuals presented with new onset

renal insufficiency, haematuria and proteinuria, and renal biopsies showed

pauci-immune necrotizing and crescentic glomerulonephritis. One of these

subjects, who had anti-myeloperoxidase autoantibodies, also developed

pulmonary vasculitis. The fifth patient presented with nephrotic syndrome

and renal biopsy findings of membranous glomerulonephritis, associated with

immune complex renal vasculitis. A pathogenic role for anti-TNFalpha therapy

is suggested by the close temporal relationship with development of

glomerular disease, and by the improvement in clinical and laboratory

abnormalities after drug withdrawal and initiation of immunosuppressive

therapy in most cases. CONCLUSIONS: Rheumatoid arthritis patients receiving

anti-TNFalpha agents may develop glomerulonephritis via the induction of

rheumatoid arthritis-related nephropathy or de novo autoimmune disorders.

PMID: 15840673

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

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