Etanercept-induced necrotizing crescentic glomerulonephritis in two patients with rheumatoid arthritis

Kaneko, Kayoko; Nanki, Toshihiro; Hosoya, Tadashi; Mizoguchi, Fumitaka; Miyasaka, Nobuyuki

doi:10.1007/s10165-010-0333-3

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…MGN has also been reported to occur with etanercept and adalimumab . Etanercept have also been linked to occurrence of crescentic GN . In addition, use of these agents is associated with increased incidence of infections, which can also affect kidneys.…”

Section: Renal Involvement In Rheumatological Diseases As a Complicatmentioning

confidence: 99%

Rheumatological diseases and kidneys: a nephrologist's perspective

Mittal

Rathi

2014

Int J Rheum Dis

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Renal involvement is a common occurrence in subjects with rheumatological diseases and can develop either due to the disease itself or secondary to drugs used in the treatment. The prevalence of renal involvement and its severity depends on the underlying disease as well as aggressiveness of the therapy. For most rheumatological diseases, renal involvement heralds a poor prognosis and warrants aggressive immunosuppressive treatment. Thus, it is important to diagnose and manage them at an early stage. On the other hand, patients with primary kidney disease can also develop rheumatological manifestations which need to be differentiated from the former. This article provides the nephrologist's perspective upon various rheumatological disorders and associated renal involvement with the aim of sensitizing the rheumatological community about them, resulting in better management of these subjects.

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Section: Renal Involvement In Rheumatological Diseases As a Complicatmentioning

confidence: 99%

Rheumatological diseases and kidneys: a nephrologist's perspective

Mittal

Rathi

2014

Int J Rheum Dis

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“…In addition, single reports reveal the presence of FSGS [139] and fibrillary glomerulonephritis [140] in RA patients. Anti-TNF alpha therapy can be causative for the development of necrotizing crescentic glomerulonephritis and proliferative lupus nephritis [141,142]. Besides the renal side effects of gold salts, D-penicillamine and bucillamine, CSA as another DMARD has a serious potential for renal toxicity, which is manifested primarily in a decline in creatinine clearance [143].…”

Section: Reviewmentioning

confidence: 99%

Renal involvement in autoimmune connective tissue diseases

Kronbichler

Mayer

2013

BMC Med

105

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Connective tissue diseases (CTDs) are a heterogeneous group of disorders that share certain clinical presentations and a disturbed immunoregulation, leading to autoantibody production. Subclinical or overt renal manifestations are frequently observed and complicate the clinical course of CTDs. Alterations of kidney function in Sjögren syndrome, systemic scleroderma (SSc), auto-immune myopathies (dermatomyositis and polymyositis), systemic lupus erythematosus (SLE), antiphospholipid syndrome nephropathy (APSN) as well as rheumatoid arthritis (RA) are frequently present and physicians should be aware of that.In SLE, renal prognosis significantly improved based on specific classification and treatment strategies adjusted to kidney biopsy findings. Patients with scleroderma renal crisis (SRC), which is usually characterized by severe hypertension, progressive decline of renal function and thrombotic microangiopathy, show a significant benefit of early angiotensin-converting-enzyme (ACE) inhibitor use in particular and strict blood pressure control in general. Treatment of the underlying autoimmune disorder or discontinuation of specific therapeutic agents improves kidney function in most patients with Sjögren syndrome, auto-immune myopathies, APSN and RA.In this review we focus on impairment of renal function in relation to underlying disease or adverse drug effects and implications on treatment decisions.

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“…In our case, Pronase-aided digestion did not reveal pathologic paraprotein deposits, supporting the idea that such deposits were not present. In addition, though tumor necrosis factor inhibition, including with etanercept, has been linked to PIGN with inconsistent ANCA serologies, the development of RPGN 2 months after stopping etanercept while on immunosuppressive therapy is unlikely [ 9 , 10 ]. With these considerations, we propose that the monoclonal protein in these cases might activate or dysregulate the complement system, or activate neutrophils by mechanisms independent of ANCA.…”

Section: Discussionmentioning

confidence: 99%

A case report of paraproteinemia-associated pauci-immune glomerulonephritis – a new form of monoclonal gammopathy of renal significance?

Rope¹,

Kambham

Arora

2017

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Background: Renal disease associated with paraproteinemias is classically predicated upon pathologic paraprotein deposition in the kidney. However, growing evidence suggests that paraproteins may be able to systemically activate complement or neutrophils to drive renal damage. This may provide an alternative pathologic mechanism for renal injury in rare cases. Case report: We report a case of a patient with crescentic pauci-immune glomerulonephritis presenting with rapidly progressive renal failure, polyarthropathy, and a purpuric rash in association with a monoclonal immunoglobulin G κ-light-chain producing multiple myeloma. Serum anti-neutrophil cytoplasmic antibodies were not detected. Kidney biopsy, including with Pronase digestion, did not reveal pathologic paraprotein deposition. Two previously published similar case reports are also discussed. Conclusion: We propose a novel pathologic mechanism involving monoclonal proteins as a trigger for pauci-immune glomerulonephritis, potentially via complement dysregulation and/or neutrophil activation. This requires further epidemiologic and mechanistic study.

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Etanercept-induced necrotizing crescentic glomerulonephritis in two patients with rheumatoid arthritis

Cited by 13 publications

References 13 publications

Rheumatological diseases and kidneys: a nephrologist's perspective

Rheumatological diseases and kidneys: a nephrologist's perspective

Renal involvement in autoimmune connective tissue diseases

A case report of paraproteinemia-associated pauci-immune glomerulonephritis – a new form of monoclonal gammopathy of renal significance?

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