Kidney involvement in rheumatoid arthritis

Abstract

Rheumatoid Arthritis (RA) is a widespread disease and its renal involvement, relatively common, is clinically significant because worsens course and mortality of the primary disease. There is still no agreement on the prevalence of renal disorders in RA: data analysis originates from different sources, as death certificates, autopsies, clinical and laboratory findings and kidney biopsies, each with its limitations. Histoimmunological studies on bioptical specimens of patients with RA and kidney damage, led to clarify prevalent pathologies. In order of frequency: glomerulonephritis and amyloidosis (60-65% and 20-30% respectively), followed by acute or chronic interstitial nephritis. Kidney injury during RA includes secondary renal amyloidosis, nephrotoxic effects of antirheumatic drugs and nephropathies as extra-articular manifestations (rheumatoid nephropathy). Amyloidosis affects survival, increases morbidity and is the main cause of end stage renal disease in patients with RA and nephropathy. Strong association between RA activity and amyloidosis needs the use of immunosuppressive and combined therapies, to prevent this complication and reduce risk of dialysis. Long-lasting and combined RA pharmacotherapy involves various renal side effects. In this review we describe NSAIDs and DMARDs (Disease-Modifying Antirheumatic Drugs) nephrotoxicity, particularly by gold compounds, D-penicillamine, cyclosporine A and methotrexate. Rare cases of IgA glomerulonephritis during immunomodulating therapy with leflunomide and TNF blocking receptor (etanercept) are reported; real clinical significance of this drug-related nephropathy will be established by development of RA treatment. In RA nephropathies, mesangial glomerulonephritis is the most frequent histological lesion (35-60 % out of biopsies from patients with urinary abnormalities and/or kidney impairment), followed by minimal change glomerulopathy (3-14%) and p-ANCA positive necrotizing crescentic glomerulonephritis

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…Мощная ассо-циация между активностью РА и АА-амилоидозом повышает заболеваемость, амилоидоз является основной причиной тХПН у пациентов с РА и по-ражением почек. Необходимо также отметить, что некоторые пожизненно применяемые виды комби-нированной фармакотерапии сами по себе облада-ют различными побочными эффектами в отноше-нии почек [82][83][84].…”

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“…The strong association between RA activity and AA amyloidosis increases morbidity and is the main cause of ESRD with RA and nephropathy. Importantly, some of the life-long and combined RA pharmacotherapy can lead to various renal side effects (82)(83)(84).…”

Renal Involvement in Rheumatic Diseases

“…Chronic or acute TIN is not relatively frequent rather than the glomerular involvement [16]. Although the prevalence is different based on several studies, mspGN and membranous nephropathy are the most frequent types of renal involvement in patients with RA [11,12,15].…”

“…The most common feature of direct renal invasion is mspGN with mesangial infiltration of mainly immunoglobulin M and G although a direct renal involvement of RA is uncommon [17]. However, membranous nephropathy is mainly associated with chronic use of NSAIDs and previous DMARDs, particularly gold compounds, D-penicillamine rather than direct renal involvement of RA [16]. Renal amyloidosis is the most common pattern of renal involvement combined with decreased renal function in patients with RA [12].…”

“…By contrast, renal dysfunction is relatively less frequent in patients with RA and renal involvement such as membranous nephropathy and mspGN. Therefore, the development of renal amyloidosis in patients with RA increases morbidity and renal mortality and is a major cause of patients with RA requiring dialysis [12,16].…”