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Fatal renal vasculitis and minimal change glomerulonephritis complicating treatment with penicillamine. Report on two
Abstract:
Two cases with different and not previously described fatal renal complications during treatment with penicillamine are reported. A man with seronegative rheumatoid arthritis with features of systemic lupus erythematosus was treated with penicillamine for six months and developed a mild membranous glomerulonephritis and a severe renal vasculitis leading to uremia and death. A woman with primary biliary cirrhosis was treated with penicillamine for nine months and developed a nephrotic syndrome, the renal biopsy showing minimal change glomerulonephritis. The nephrotic syndrome responded to prednisone but the patient died, probably from septicemia. Penicillamine may thus cause glomerular damage without deposition of immune complexes. A restricted use of the drug is recommended.
Insights
Penicillamine treatment can cause severe, fatal kidney complications like glomerulonephritis and vasculitis, even without immune complex deposition. Doctors recommend restricted use of this drug due to these risks.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Penicillamine is a chelating agent used to treat conditions like rheumatoid arthritis and primary biliary cirrhosis.
- While effective, its potential adverse effects, particularly renal complications, require careful monitoring.
- Understanding the mechanisms of penicillamine-induced nephrotoxicity is crucial for patient safety.
Observation:
- Two distinct cases of fatal renal complications during penicillamine therapy are presented.
- Case 1: A patient with rheumatoid arthritis developed membranous glomerulonephritis and severe renal vasculitis, leading to death.
- Case 2: A patient with primary biliary cirrhosis developed nephrotic syndrome with minimal change glomerulonephritis, which responded to prednisone but was followed by death, likely from septicemia.
Findings:
- Penicillamine can induce glomerular damage through mechanisms independent of immune complex deposition.
- The reported cases highlight previously undescribed fatal renal outcomes associated with penicillamine treatment.
- Renal vasculitis and minimal change glomerulonephritis represent distinct patterns of penicillamine-induced kidney injury.
Implications:
- The findings suggest a need for increased vigilance and potentially restricted use of penicillamine, especially in patients with pre-existing renal risk factors.
- Further research into the pathogenesis of penicillamine nephrotoxicity is warranted to develop safer treatment strategies.
- This study underscores the importance of early detection and management of renal adverse events in patients receiving penicillamine therapy.