RESEARCH - The problem of rheumatoid nephropathy

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Ter Arkh. 2003;75(5):24-9.

[The problem of rheumatoid nephropathy]

[Article in Russian]

Kanevskaia MZ, Varshavskii VA.

AIM: To study clinical and morphological variants and frequency of renal

involvement in patients with rheumatoid arthritis (RA). MATERIAL AND

METHODS: Routine laboratory tests, device (urography, dynamic scintigraphy

of the kidneys) and ultrasound investigations, lifetime and postmortem

examinations of renal tissue using histological, immunohistochemical and

electron-microscopic techniques, biopsy of gingival and rectal mucosa for

amyloid detected renal lesions in 268 (46.2%) of RA patients followed up for

25 years meeting the ARA criteria. In 98 (37%) patients renal lesions were

verified morphologically. Lifetime renal biopsies were made for 60 of them.

RESULTS: The diagnosis of chronic pyelonephritis was made in 117 patients,

42 patients had nephrolithlasis, nephroptosis and papillary necrosis were

found in 49 and 3 patients, respectively. Arterial hypertension was present

in 96 examinees, nephrotic syndrome was diagnosed in 19 and chronic renal

failure--in 67 patients. Drug-related nephropathy occurred in 35 cases, in

26 cases symptoms of pyelonephritis arose prior to RA. Combination of renal

diseases was found in 197 patients. Renal pathology was not verified

morphologically only in 5 cases. Glomerulonephritis (GN) variants were

present in 35 patients: mesangioproliferative (n = 27), membraneous (n = 5),

mesangiocapillary (n = 3). 12 of them took Au preparations or

D-penicillamin, therefore diagnosis of true rheumatoid GN was feasible only

in 23 of them. GN was combined with renal amyloidosis (n = 28), minimal

morphological changes (n = 19), interstitial/tubulointerstitial nephritis (n

= 4), pyelonephritis (n = 4), arteriolosclerotic nephrosclerosis (n = 3). 41

patients with diagnosed pyelonephritis were found morphologically to have

amyloidosis (n = 16), GN (n = 10), minimal morphological changes of renal

tissue (n = 6), tubulointerstitial nephritis (n = 3), pyelonephritis,

pyelonephritis alone (n = 4). CONCLUSION: The above morphological findings

point to high occurrence of renal pathology in RA. In many cases

morphological signs are more serious than clinical symptoms. If RA activity

is not controlled, nephritis of any type may transform into amyloidosis.

When it is impossible to formulate morphological diagnosis in RA patients,

it is proposed to use the term " nephropathy " . Unrelated to RA nephropathy's

diagnosis is valid in cases when renal pathology manifested before RA. Renal

diseases arising in the presence of RA may be associated with this disease

and should be reflected in its classification.

PMID: 12847893

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=12847893 & itool=iconabstr & query_hl=13 & itool=pubmed_DocSum

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