Kidney Disease in Ankylosing Spondylitis: a case series and review of the literature

Abstract

Background Kidney disease is a rare manifestation of ankylosing spondylitis (AS) and its pathological alterations remain poorly described. The aim of this study was to investigate the clinical presentation and pathological alterations on kidney biopsy of AS patients and review and discuss the current literature on the issue. Methods: We retrospectively studied the clinical presentation and kidney pathological alterations of 15 Caucasian AS patients submitted to kidney biopsy between October 1985 and March 2021. Results: Patients were predominantly male (66.7%) with median age at the time of kideney biopsy of 47 years [IQR 34 - 62]. Median serum creatinine at presentation was 1.3 mg/dL [IQR 0.9 - 3] and most patients also had either proteinuria (85.7%) and/or hematuria (42.8%). The most common indication for kidney biopsy was nephrotic syndrome (33.3%), followed by acute or rapidly progressive kidney injury (20%) and chronic kidney disease of unknown etiology (20%). Chronic interstitial nephritis (CIN) (n=3) and AA amyloidosis (n=3) were the most common diagnosis. Others included IgA nephropathy (IgAN) (n=2), focal segmental glomerulosclerosis (n=2), membranous nephropathy (n=1), and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN)(n=1). Conclusions: We present one of the largest series of biopsy-proven kidney disease in Caucasian AS patients. We found a lower prevalence of IgAN than previously reported in Asian cohorts. We found a higher prevalence of CIN and a lower prevalence of AA amyloidosis than that described in previous series of Caucasian patients. We also present the first case of AS-associated IC-MPGN.

Focal Segmental Glomerulosclerosis and Hyalinosis in a Patient with Spondyloarthritis: A Rare Renal Involvement Case Report

“… 7 , 9 AA amyloidosis, IgA nephropathy, and urolithiasis are the most common causes of renal involvement in SpA in the Caucasian population. 6 , 10 …”

“…Cases of membranous glomerulonephritis, mesangial glomerulonephritis with C3 and IgM deposits, and membranoproliferative glomerulonephritis have been reported. 7 , 10 , 13 , 14 …”

Thoracic manifestations and respiratory function alterations in axial spondyloarthritis and newest possibilities of ultrasound to detect changes in diaphragm—a narrative review

“…In axSpA, there are often extra-articular manifestations of the disease that are part of the SpA concept, but also those that are not. Considering the organ system affected, they can be divided into: ocular manifestations (uveitis—mostly unilateral, acute, anterior uveitis) ( 5 ), gastrointestinal (inflammatory bowel disease) ( 6 , 7 ), skin (psoriasis) ( 8 ), bone (osteoporosis and associated low energy vertebral fractures) ( 9 ), cardiovascular (conduction disorders, valvular heart disease, cardiomyopathy, atherosclerosis, thrombosis, aortitis, pericarditis, vasculitis) ( 10 - 13 ), renal disease (IgA glomerulonephritis, amyloid deposition, microhaematuria, microalbuminuria, impaired renal function) ( 14 ) and pulmonary manifestations, described in detail later.…”