Gold Nephropathy

Hall, Clive L.

doi:10.1159/000185185

Cited by 20 publications

(6 citation statements)

References 27 publications

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“…It is not known why the lesions of membranous GN are sometimes segmental, a feature relatively common in RA-associated membranous lesions (22). Membranous GN with segmental deposition of immunoglobulin is probably not a mild form of the disease, because the levels of maximal and current proteinuria were equal to those in patients with membranous GN with diffuse alterations.…”

Section: Discussionmentioning

confidence: 97%

Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis

Helin

Korpela

Mustonen

et al. 1995

Arthritis & Rheumatism

169

110

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Objective. To evaluate renal biopsy findings and clinicopathologic correlations in patients with rheumatoid arthritis (RA). Methods. Retrospective study of renal biopsy specimens from 110 RA patients in whom the clinical renal disease was probably due to RA itself and/or to antirheumatic therapy. Results. The most common histopathologic finding was mesangial glomerulonephritis (GN) (n = 40), followed by amyloidosis (n = 33), membranous GN (n = 19), focal proliferative GN (n = 4), minimal‐change nephropathy (n = 3), and acute interstitial nephritis (n = 1). Amyloidosis was the most common finding in patients with the nephrotic syndrome. In patients with isolated proteinuria, amyloidosis, membranous GN, and mesangial GN were almost equally common. Although mesangial GN was found in almost two‐thirds of the RA patients with hematuria (with or without proteinuria), there still remained a 1 in 5 chance that the biopsy would reveal membranous GN or amyloidosis. Membranous GN was closely related to gold or D‐penicillamine therapies, whereas mesangial GN probably related to RA itself. Conclusion. The renal morphologic lesion in RA patients with isolated proteinuria and those with hematuria cannot be accurately predicted on the basis of clinical symptoms and signs. Biopsy is thus useful in differential diagnosis, assessment of prognosis, and decision‐making with regard to treatment.

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Section: Discussionmentioning

confidence: 97%

Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis

Helin

Korpela

Mustonen

et al. 1995

Arthritis & Rheumatism

169

110

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“…13 Although it is widely accepted that gold may have an anti-inflammatory effect, it may cause hypersensitivity and tissue inflammation. 7,14,25 In vivo and in vitro studies have shown that metallic gold implants release gold ions in tissues and cell cultures as a result of interaction with oxidative agents most likely provided by macrophages. 4,18 Some believe that the pro-inflammatory properties of gold can be attributed to ionized gold and its metabolites.…”

mentioning

confidence: 99%

Inflammatory Response to Therapeutic Gold Bead Implantation in Canine Hip Joint Osteoarthritis

et al. 2010

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Inflammatory changes associated with periarticular pure gold bead implants were studied in dogs involved in a clinical trial investigating motor dysfunction and chronic pain owing to hip joint dysplasia and osteoarthritis. Gold beads were percutaneously implanted via a needle into different locations surrounding the greater trochanter of the femur. Nine dogs with implants were necropsied. In all examined animals, characteristic histologic lesions were observed in the tissue surrounding the gold implants-namely, a fibrous capsule composed of concentric fibroblasts intermixed with a variable number of inflammatory cells and a paucicellular innermost layer of collagen with a few fibrocyte-like cells in empty lacunae. Lymphocytes dominated the inflammatory infiltrate, with rarely observed macrophages present in close proximity to the implant site. No giant cells were observed. Immunohistochemistry showed mixed populations of lymphocytes, both CD3 positive (T cells) and CD79a positive (B cells), which in some cases formed lymphoid follicles. Diffuse inflammatory changes were present to a minor extent in the perimysium and surrounding fascia. The inflammation observed in dogs is similar to that observed with gold implants in humans. It is possible that the clinically beneficial effect of gold beads for chronic osteoarthritis depends on sustained localized inflammation with localized release of soluble mediators. The encapsulation of the implant by a paucicellular and poorly vascularized fibrous capsule may help prevent an exaggerated inflammatory reaction by sequestering the gold bead from the surrounding tissue. Keywords B cells, dogs, gold implants, immunohistochemistry, inflammation, osteoarthritis, T cellsThe parenteral therapeutic use of gold salts (chrysotherapy) is well known in human medicine and has been used in cases of rheumatoid arthritis. 23 The mechanisms behind the anti-inflammatory effect of monovalent gold salts and its metabolites, such as Au 3þ , Au(CN) 2 -, and metallic gold, is incompletely understood.5 One proposed mechanism of action for Au þ is due to binding with thiolate and thioether ligands on proteins.5 This is thought to inhibit presentation of complexed antigen to T cells, activity of certain transcription factors, and enzymes such as protein tyrosine phosphatase in T cells, protein kinase C in neutrophils and T cells, and proteins important for B cell differentiation. Au(CN) 2 -is an effective inhibitor of the respiratory burst of neutrophils and monocytes; it also inhibits the proliferation of lymphocytes. 5A more recent therapeutic application of gold is the implantation of gold beads directly into a painful anatomic region, such as the periarticular tissue of arthritic joints. This technique is derived from acupuncture and has been used in veterinary medicine for the past decade, largely as a treatment in canine hip dysplasia.10 A recent double-blind, placebocontrolled clinical trial performed by Jaeger et al showed that the performance of dogs with hip joint osteoarthritis s...

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“…33,34 Kidney function is generally well maintained. 33,34 Kidney function is generally well maintained.…”

Section: Proteinuria With or Without Nephrotic Syndromementioning

confidence: 99%

Renal disease in elderly patients

Porush

Faubert

1997

Rev. Clin. Gerontol.

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Like other organs in the body, the kidneys undergo age-associated anatomical, structural and physiological changes. Starting at 50 years of age, there is a 3-10% decline in kidney weight for each subsequent decade of life, with the loss of cortical mass greater than medullary mass. In fact, the number of glomeruli start to decrease progressively after age 40, and the number of sclerotic glomeruli increases, making the distinction between involutional and disease-related sclerosis unclear in some cases. The outer cortical glomeruli are, in general, more extensively involved than deeper glomeruli, but glomerular size does not change. In general, the loss of the glomerular mass is proportional to the loss of tubular mass, maintaining glomerulotubular balance. In addition to glomerular sclerosis, there is a gradual increase in interstitial fibrosis, and there is focal thickening of both glomerular and tubular basement membranes, probably due to the accumulation of type IV collagen.

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Gold Nephropathy

Cited by 20 publications

References 27 publications

Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis

Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis

Inflammatory Response to Therapeutic Gold Bead Implantation in Canine Hip Joint Osteoarthritis

Renal disease in elderly patients

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