Renal lesions associated with gold therapy light and electron microscopic studies

Abstract

Light and electron microscopic studies were performed on renal biopsies of three patients who developed proteinuria following injections of gold in the treatment of rheumatoid arthritis. The renal lesions were shown to be lipoid nephrosis in one patient and membranous glomerulonephritis in two patients. One of the three cases developed a typical nephrotic syndrome. In the cases presented, gold was felt to be the antigenic stimulus promoting the development of the renal lesion.Studios de microscopia optic e electronic esseva executate in biopsias renal de tres patientes qui disveloppava proteinuria post injectiones de auro in le tractamento de arthritis rheumatoide. Esseva constatate que le lesiones renal esseva nephrosis lipoide in un caso e glomerulonephritis membranose in le duo alteres. Un del tres patientes disveloppava un typic syndrome nephrotic. In le casos presentate il esseva opinate que auro esseva le agente del stimulo antigenic que promoveva le disveloppamento del lesion renal, HE NEPHROTIC SYNDROME as a complication of drug therapy has T been reported following the administration of a number of chemical agents including probenecid,l paramethadione,2 trimethadione,3-? tolbutamide,s perchlorateg and penkillaminel0 etc. Several papers have noted the association of the nephrotic syndrome with compounds containing heavy metals, particularly mercury,11-14 although b i s m~t h~~~~~ and gold salt^^'-^^ have also been incriminated. Numerous reports of gold therapy followed by renal lesions are also found in the European literature. Many of these are mentioned by Gregoire et. al.,25 Rathenz et. a1.26 and by Derot et. al.27 Published photomicrographs have shown thickening of the glomerular basement membrane. However, both gold2? and mercuryz8 can produce acute tubular necrosis accompanied by renal failure.This report describes renal lesions in three patients following injections of gold sodium thiomalate and gold sodium thiosulfate for rheumatoid arthritis. Light and electron microscopic studies of rend biopsy material from

The Influence of Gold Salts on the Urinary Enzyme Level

“…This could create prerequisite conditions for the formation of irritating concentrations of gold salts in the renal tissue. The fact remains that in the morphological picture of renal damage in the course of chrysotherapy, tubular damage is not in the fore and membranous glomerulonephritis predominates (4,6,9). On the other hand, a dominant feature of acute renal damage by salts of heavy metals is tubular necrosis.…”

Haematuria in rheumatoid arthritis: a follow up study.

“…lamine,1 2 the presence of a similar renal lesion relating to rheumatoid arthritis itself has proved debatable.3 4 In a previous paper we described changes of mesangial glomerulonephritis in most renal biopsy specimens obtained from patients with rheumatoid arthritis and persistent haematuria,5 most of whom had never received second line drugs. The prognosis for the patients with established mesangial glomerulonephritis and rheumatoid arthritis appeared to be good as none of them showed a reduction in creatinine clearance at the time of initial diagnosis.…”

Metals and Kidney Autoimmunity

“…Numerous reports ofgold therapy followed by renal lesions can be found in the literature of the 1960s and 1970s (85,(119)(120)(121). Proteinuria was detected in 6-17% and a nephrotic syndrome in 2.6-5.3% of RA patients treated with gold salts (86).…”