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Simultaneous occurrence of perimembranous glomerulonephritis and glomerular amyloidosis
Abstract:
The results of electron microscopic examination of renal biopsies from 3 patients with rheumatoid arthritis treated with penicillamine are presented. All 3 patients developed a nephrotic syndrome upon discontinuation of penicillamine therapy. When viewed with the electron microscope, segmental forms of perimembranous glomerulonephritis (Stages I-II of Ehrenreich and Churg) and glomerular renal amyloidosis Grade I-III were observed. In all three cases the nephrotic syndrome was considered to be due to the simultaneous occurrence of the two disease processes. In 2 cases perimembranous glomerulonephritis with immuno-complex-deposits was assumed to be the dominant factor in the causation of the disease, in the other case amyloidosis was the principle abnormality.
Insights
Penicillamine treatment for rheumatoid arthritis can lead to nephrotic syndrome. Renal biopsies revealed co-occurring perimembranous glomerulonephritis and amyloidosis as the cause.
Area of Science:
- Nephrology
- Rheumatology
- Pathology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Penicillamine is a chelating agent used in treating RA.
- Nephrotic syndrome is a kidney disorder characterized by heavy protein loss.
Observation:
- Electron microscopy of renal biopsies from 3 RA patients treated with penicillamine was performed.
- All patients developed nephrotic syndrome after discontinuing penicillamine.
- Segmental perimembranous glomerulonephritis and glomerular renal amyloidosis were observed.
Findings:
- The nephrotic syndrome was attributed to the simultaneous occurrence of perimembranous glomerulonephritis and renal amyloidosis.
- Perimembranous glomerulonephritis with immune complex deposits was the primary cause in 2 cases.
- Renal amyloidosis was the primary cause in 1 case.
Implications:
- This study highlights potential renal complications of penicillamine therapy in RA patients.
- Simultaneous glomerulonephritis and amyloidosis can cause nephrotic syndrome.
- Understanding these co-existing pathologies is crucial for patient management.