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Acute glomerulonephritis occurring during immunoadsorption with staphylococcal protein A column (Prosorba)
Jose Iglesias1, Vivette D D'Agati, Jerrold S Levine
1The Department of Medicine, Division of Nephrology, Jersey Shore University Medical Center, The Robert Wood Johnson School of Medicine U.M.D.N.J., Neptune, NJ, USA. jiglesias@verizon.net
Summary
Staphylococcal protein A (SPA) immunoadsorption can cause glomerulonephritis (GN), especially in rheumatoid arthritis (RA) patients. Leukocytoclastic vasculitis is a key risk factor for developing GN during this autoimmune disorder treatment.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Immunoadsorption using staphylococcal protein A (SPA) columns is a treatment for various autoimmune disorders.
- Leukocytoclastic vasculitis is a known, though uncommon, complication of SPA immunoadsorption therapy.
Observation:
- This case series reports immune complex glomerulonephritis (GN) in a patient with rheumatoid arthritis (RA) undergoing SPA (Prosorba) immunoadsorption.
- Seven additional potential cases of GN were identified in patients treated with Prosorba, primarily those with RA.
Findings:
- Renal biopsies confirmed immune complex GN in affected patients.
- The incidence of GN in RA patients treated with Prosorba was 1.75%, similar to leukocytoclastic vasculitis.
- Leukocytoclastic vasculitis significantly increased the risk of GN (RR=75.95).
- RA patients had a substantially higher risk of GN compared to ITP patients (RR=62.95).
Implications:
- SPA immunoadsorption carries a risk of GN, particularly in patients with rheumatoid arthritis.
- The presence of leukocytoclastic vasculitis is a critical risk factor for GN development.
- Clinicians should be vigilant for renal complications in patients undergoing SPA immunoadsorption, especially those with RA.