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[Perimembranous glomerulonephritis after treatment with D-penicillamine. Report on 31 cases (author's transl)]
Abstract:
This report includes 31 patients who developed a perimembranous glomerulonephritis generally 7 months after the onset of the treatment of various illnesses with D-Penicillamine. In all cases the patients had a proteinuria, associated with a hematuria in 12 cases. After the treatment was stopped 8 patients rapidly developed a nephrotic syndrome, while its onset was more gradual in 12 other patients. 5 patients initially with a nephrotic syndrome had no proteinuria at the time of a second biopsy made up to 12 months later. In these 5 cases the typical changes of perimembranous glomerulonephritis observed on electron microscopy were much reduced in the second biopsy.
Insights
D-Penicillamine treatment can cause perimembranous glomerulonephritis, leading to proteinuria and nephrotic syndrome in patients. Kidney function may improve after discontinuing D-Penicillamine therapy.
Area of Science:
- Nephrology
- Pharmacology
- Pathology
Background:
- D-Penicillamine is a chelating agent used to treat various conditions.
- Drug-induced nephropathies are a significant concern in clinical practice.
Observation:
- Thirty-one patients developed perimembranous glomerulonephritis (MPGN) after D-Penicillamine treatment.
- Common symptoms included proteinuria and, in some cases, hematuria.
- Nephrotic syndrome developed in 20 patients after treatment cessation.
Findings:
- MPGN onset typically occurred around 7 months into D-Penicillamine therapy.
- Proteinuria was a consistent finding, with hematuria present in 12 patients.
- Five patients showed reduced MPGN on repeat biopsy after treatment withdrawal, indicating potential reversibility.
Implications:
- Discontinuation of D-Penicillamine may lead to recovery from drug-induced MPGN.
- Monitoring for renal complications is crucial in patients receiving D-Penicillamine.
- Understanding the pathogenesis of D-Penicillamine-induced nephropathy can inform treatment strategies.