Tocilizumab improves systemic rheumatoid vasculitis with necrotizing crescentic glomerulonephritis
Takashi Iijima1, Tatsuya Suwabe, Keiichi Sumida
1Nephrology Center, Toranomon Hospital Kajigaya , 1-3-1 Kajigaya, Takatsu, 213-8587, Kawasaki, Kanagawa , Japan.
Modern Rheumatology
|February 19, 2014
Summary
Systemic rheumatoid vasculitis (SRV) can lead to necrotizing crescentic glomerulonephritis (NCGN). Tocilizumab treatment improved renal function and proteinuria in a patient with SRV and NCGN.
Area of Science:
- Rheumatology
- Nephrology
- Immunology
Background:
- Systemic rheumatoid vasculitis (SRV) is a rare extra-articular manifestation of rheumatoid arthritis.
- Necrotizing crescentic glomerulonephritis (NCGN) is a severe form of kidney disease characterized by rapid progression.
Observation:
- A Japanese woman with a history of rheumatoid arthritis developed multiple systemic complications including interstitial pneumonia, hepatitis, rheumatoid nodules, mononeuritis multiplex, and hypocomplementemia.
- At age 51, she experienced rapidly progressive renal failure with nephrotic proteinuria, diagnosed as NCGN with subepithelial deposits on renal biopsy.
- Despite severe joint destruction and scleritis, anti-neutrophil cytoplasmic antibodies were negative.
Findings:
- Diagnosis of SRV was confirmed due to multi-organ involvement.
- Treatment with tocilizumab (an anti-interleukin-6 receptor antibody) was initiated at 280 mg monthly.
- After 18 months of therapy, serum creatinine improved from 1.7 to 1.3 mg/dL, and daily urinary protein excretion decreased from 5.2 to 1.2 g.
Implications:
- Tocilizumab demonstrated efficacy in improving renal function and reducing proteinuria in this patient with SRV and NCGN.
- This suggests that anti-interleukin-6 receptor therapy may be a viable treatment option for SRV complicated by NCGN.
- Further research is warranted to confirm the therapeutic potential of tocilizumab in this specific clinical context.
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