Mesangial glomerulopathy in rheumatoid arthritis patients. Clinical follow-up and relation to antirheumatic therapy
Related Experiment Videos
M Korpela1, J Mustonen, A Pasternack
1Department of Clinical, University of Tampere, Finland.
Abstract:
23 patients (16 women, 7 men) with rheumatoid arthritis (RA) and renal biopsy-proven mesangial glomerulopathy (MGP) were followed for 4-117 months (median 42) in order to evaluate the clinical course of their renal disease. Urinalysis was made, and 24-hour urine protein excretion and serum creatinine were determined. At the time of renal biopsy, the clinical renal findings of the patients were isolated hematuria (n = 10), isolated proteinuria (n = 6) and hematuria combined with proteinuria (n = 7). Hematuria persisted and renal function remained normal in all patients with isolated hematuria. A possible association between the presence of hematuria and the use of antirheumatic drugs was not established in this study. Proteinuria was clinically closely associated with the use of antirheumatic drugs in 9 out of 13 cases (6 with gold sodium thiomalate, 2 with D-penicillamine and 1 with auranofin) suggesting that antirheumatic drugs are important contributors to proteinuria in these patients. Renal function, although initially reduced in some patients, remained stable in all but 1 patient with IgA glomerulonephritis who developed the nephrotic syndrome and died of uremia. In conclusion, the clinical course of MGP in RA patients is benign in most patients. Moreover, this nephropathy may not represent a clinical entity. Proteinuria was related to antirheumatic drugs in most patients whereas microhematuria was constant even after stopping the antirheumatic drugs.
Insights
Rheumatoid arthritis patients with mesangial glomerulopathy (MGP) often experience stable kidney function. Proteinuria in these patients is frequently linked to antirheumatic drug use, while hematuria persists independently.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Rheumatoid arthritis (RA) is a systemic autoimmune disease.
- Mesangial glomerulopathy (MGP) is a kidney biopsy finding that can occur in RA patients.
- The clinical course and renal outcomes of MGP in RA patients require further elucidation.
Purpose of the Study:
- To evaluate the clinical course of renal disease in patients with rheumatoid arthritis and biopsy-proven mesangial glomerulopathy.
- To determine the association between antirheumatic drug use and renal manifestations in this patient cohort.
Main Methods:
- Retrospective follow-up of 23 RA patients with MGP for 4-117 months.
- Assessment of urinalysis, 24-hour urine protein excretion, and serum creatinine.
- Analysis of clinical renal findings at the time of renal biopsy.
Main Results:
- Isolated hematuria persisted in all patients, with normal renal function.
- Proteinuria was closely associated with antirheumatic drug use in 9 of 13 cases.
- Renal function remained stable in most patients, with one exception developing uremia.
Conclusions:
- Mesangial glomerulopathy in RA patients typically follows a benign clinical course.
- Proteinuria is often related to antirheumatic drug use, whereas microhematuria is a persistent finding.
- MGP may not represent a distinct clinical entity in the context of rheumatoid arthritis.