[Kidney involvement in rheumatoid arthritis].

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Rheumatoid Arthritis (RA) is a systemic autoimmune disease with significant renal involvement, impacting patient prognosis and mortality.
• The prevalence of kidney disorders in RA is debated due to varied data sources and inherent limitations.
• Histoimmunological studies of kidney biopsies are crucial for understanding prevalent pathologies in RA-related nephropathy.

Purpose of the Study:

• To review the spectrum of kidney diseases associated with Rheumatoid Arthritis.
• To elucidate the prevalence and histological characteristics of renal pathologies in RA patients.
• To discuss the nephrotoxic effects of antirheumatic drugs and their clinical significance.

Main Methods:

• Review of histoimmunological studies on kidney biopsy specimens from RA patients with renal damage.
• Analysis of data from clinical findings, laboratory results, death certificates, and autopsies.
• Compilation of information on drug-induced nephrotoxicity from long-term RA pharmacotherapy.

Main Results:

• The most frequent renal pathologies in RA are glomerulonephritis (60-65%) and amyloidosis (20-30%), followed by interstitial nephritis.
• Secondary renal amyloidosis is a major cause of end-stage renal disease in RA, strongly associated with disease activity.
• Mesangial glomerulonephritis is the most common histological finding (35-60%) in RA nephropathies, followed by minimal change glomerulopathy and crescentic glomerulonephritis.

Conclusions:

• Kidney injury in RA encompasses secondary amyloidosis, drug toxicity, and rheumatoid nephropathy, significantly affecting survival.
• Aggressive management of RA activity with immunosuppressive and combined therapies is vital to prevent amyloidosis and reduce dialysis risk.
• Various Disease-Modifying Antirheumatic Drugs (DMARDs) and NSAIDs pose renal side effects, necessitating careful monitoring.