Tocilizumab-induced immunocomplex glomerulonephritis: a report of two cases
Daichi Fukaya1, Tsutomu Inoue1, Yuta Kogure2
1Department of Nephrology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan.
CEN Case Reports
|April 28, 2020
Summary
Tocilizumab treatment for rheumatoid arthritis can rarely cause membranoproliferative glomerulonephritis. Renal impairment resolved after stopping tocilizumab and with prednisolone treatment.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Tocilizumab is an interleukin-6 receptor inhibitor used for rheumatoid arthritis.
- Autoimmune disorders are rare side effects of tocilizumab therapy.
Observation:
- Two cases of membranoproliferative glomerulonephritis (MPGN) developed during tocilizumab treatment for rheumatoid arthritis.
- Patients presented with proteinuria, hematuria, and lower leg edema.
- One patient was positive for anti-nuclear antibody; both had hypocomplementemia.
Findings:
- Renal biopsies confirmed immunocomplex glomerulonephritis with IgG, IgA, IgM, and C3 deposition.
- Renal impairment resolved after discontinuing tocilizumab and initiating oral prednisolone.
- Clinical courses and pathological findings were similar to a previously reported case.
Implications:
- Membranoproliferative glomerulonephritis is a rare but potential adverse effect of tocilizumab therapy.
- Clinicians should monitor for autoimmune complications during tocilizumab treatment.
- Awareness of this rare side effect is crucial for patient management.
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