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Penicillamine and nephrotic syndrome.
George S Habib1, Walid Saliba, Munir Nashashibi
1Department of Medicine, Carmel Medical Center, Faculty of Medicine, Technion, Israel Institute of Technology, 7 Michal Street 34362 Haifa, Israel. gshabib62@yahoo.com
European Journal of Internal Medicine
|July 26, 2006
Summary
Penicillamine (PA) treatment can cause nephrotic syndrome (NS), often presenting with membranous glomerulonephritis. Stopping PA typically resolves proteinuria within 7 months, with corticosteroids potentially speeding recovery.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Penicillamine (PA) is associated with diverse adverse effects, including nephrotic syndrome (NS).
- Previous reports on PA-induced NS are limited to case reports and small series.
- This study reviews English literature for NS cases attributed to PA treatment.
Purpose of the Study:
- To comprehensively review and analyze cases of nephrotic syndrome (NS) caused by penicillamine (PA) treatment.
- To identify common clinical, pathological, and outcome features of PA-induced NS.
Main Methods:
- Retrospective Medline search (1963-2004) using terms 'penicillamine' and 'proteinuria' or 'nephrotic'.
- Inclusion criteria: sufficient clinical/laboratory data, and NS attributed to PA.
- Documented data included patient diagnosis, PA dose/duration, proteinuria levels, renal function, biopsy findings, treatment, and outcomes.
Main Results:
- Sixty-three patients met criteria; 75% had rheumatoid arthritis (RA).
- Mean PA treatment duration before NS diagnosis was 11.9 months; peak proteinuria averaged 10.79 g.
- Membranous glomerulonephritis (55%) and minimal change disease (27%) were common; 33% developed renal failure. Proteinuria resolved in most patients after stopping PA, faster with corticosteroid (CS) treatment.
Conclusions:
- PA-induced NS typically develops after approximately one year of treatment.
- Membranous glomerulonephritis is the most frequent histopathological finding.
- Discontinuation of PA leads to proteinuria resolution within 7 months, accelerated by CS.