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Rapidly progressive glomerulonephritis with D-penicillamine
1Institute of Rheumatology, Tokyo Women's Medical University, Japan. ynn@ior.twmu.ac.jp
The American Journal of the Medical Sciences
|January 10, 2001
Summary
D-penicillamine (D-PC) treatment for rheumatoid arthritis can trigger anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive glomerulonephritis. Prompt immunosuppressive therapy improved renal function and resolved MPO-ANCA positivity in these cases.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- D-penicillamine (D-PC) is a chelating agent used to treat RA.
- Drug-induced kidney injury is a significant concern in RA treatment.
Observation:
- Three RA patients developed rapidly progressive glomerulonephritis (RPGN) during D-PC therapy.
- Patients presented with proteinuria, hematuria, renal insufficiency, and anemia.
- High levels of anti-myeloperoxidase (MPO)-ANCA were detected in all patients.
Findings:
- Renal biopsy revealed glomerulonephritis with cellular crescents and immune deposits (IgG, IgM, IgA, C1q, C3).
- Discontinuation of D-PC was followed by immunosuppressive treatment (steroids, anticoagulants, cyclophosphamide).
- Patients showed gradual improvement in renal function and MPO-ANCA seronegativity post-treatment.
Implications:
- D-penicillamine can induce MPO-ANCA-positive RPGN in rheumatoid arthritis patients.
- Early diagnosis and immunosuppressive treatment are crucial for managing D-PC-induced glomerulonephritis.
- This highlights the importance of monitoring renal function in patients treated with D-PC.