Granulomatous glomerulonephritis in a patient with rheumatoid arthritis treated with gold salts

The clinical course of rheumatoid arthritis in the patient described was characterized by two episodes of microhaematuria, both occurring shortly after the administration of gold salt. The second of these episodes developed into progressive renal failure. Renal biopsy disclosed a rarely described granulomatous glomerulonephritis. Various known pathogenic mechanisms of renal injury are evaluated concerning their applicability in this patient. However, although it is believed that the gold salt therapy was the main agent in the pathogenesis of this fatal renal complication, the mechanism whereby such a pathogenesis proceeded remains unclear.