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Penicillamine-induced proteinuria: risk factors
Penicillamine-induced proteinuria occurred in 9% of rheumatoid arthritis patients, but was reversible in all cases. Careful monitoring is advised for patients with prior gold-induced proteinuria, as penicillamine can often be safely continued or restarted.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Penicillamine is a disease-modifying antirheumatic drug (DMARD) used in RA treatment.
- Proteinuria is a potential adverse effect of penicillamine therapy.
Purpose of the Study:
- To investigate the incidence, characteristics, and risk factors of penicillamine-induced proteinuria in rheumatoid arthritis patients.
- To assess the reversibility of proteinuria and the possibility of continuing or restarting penicillamine therapy.
Main Methods:
- Retrospective analysis of 300 rheumatoid arthritis patients treated with penicillamine.
- Monitoring for proteinuria and renal function.
- Identification of risk factors including HLA types and prior gold therapy.
Main Results:
- Proteinuria developed in 9% of patients (26/300) at a mean dose of 591 mg/day and 9 months duration.
- Proteinuria resolved in all patients within a mean of 5.5 months.
- Twelve patients were successfully restarted or maintained on penicillamine with proteinuria resolution.
- HLA-B8, DR3, and prior gold-induced proteinuria were identified as risk factors.
Conclusions:
- Penicillamine-induced proteinuria in RA patients is generally reversible with no permanent renal impairment.
- Patients with prior gold-induced proteinuria require closer monitoring but can often continue or restart penicillamine.
- Tissue typing is not recommended due to the reversible nature of the proteinuria.
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