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Renal Involvement in Rheumatoid Arthritis: Analysis of 53 Renal Biopsies
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Advisor(s)
Abstract(s)
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disorder characterized by joint inflammation,
associated with autoantibody production. Renal involvement arises as a complication of treatment or can
be related to the disease itself.
Methods: 53 biopsies from patients with RA from 1989 to 2015 were reviewed. Histologic diagnosis, age,
gender, duration of RA, drug therapy, renal function, proteinuria and haematuria were analyzed.
Results: Amyloidosis was the most common renal histologic pattern (21 patients). Membranous Nephropathy
(MN) was found in 12 patients, followed by Mesangial Proliferative Glomerulonephritis (n=4) and Focal and
Segmental Glomerulosclerosis (n=4), IgA Nephropathy (n=3), Necrotizing Glomerulonephritis (n=3), Chronic
Interstitial Nephritis (n=3), Endocapillary Proliferative Glomerulonephritis (n=2) and Minimal Change Disease
(n=1). Amyloidosis correlated with long duration RA (14.9±6.66 years vs 8.84±6.37 years; p<0.001), presenting
with nephrotic proteinuria in the majority of the cases (5.11±2.94 g/24h vs 3.52±2.71 g/24h p=0.03), which correlates
with dominant glomerular amyloid deposition (7.0±2.28 g/24h vs 3.04±2.08 g/24h; p<0.001). In patients
with MN, renal function was preserved (serum creatinine 0.83±0.21mg/dl vs 2.03±0.21mg/dl; p<0.001) and one
third of the cases presented with haematoproteinuria. Disease modifying antirheumatic drugs (DMARDs) could
be related with MN in six cases. Patients with Necrotizing Glomerulonephritis had a severe renal involvement,
as did patients with Chronic Interstitial Nephritis.
Conclusion: We found a wide spectrum of histological lesions that cannot be predicted with only clinical and
laboratory findings. Thus, renal biopsy is essential to ensure correct diagnosis in RA patients who present with
urinary abnormalities or deteriorated renal function.
Description
Keywords
Glomerulonephritis Renal Biopsy Rheumatoid Arthritis HCC NEF
Citation
Port J Nephrol Hypert 2017; 31(1): 25-30