Glomerulonephritis in Two Patients with SpA Treated with TNF-α Blockers and a Review of the Literature

Figures & data

Table 1 Case Reports of Anti-TNF-α-Induced Glomerular Disease in SpA

Patient	Disease	Anti-TNFα**	Renal Abnormalities	Kidney Biopsy	Ref.
♂ 27	AS	GLM/ADA	↑ u-Prot, RBC,casts	IgA mGN and MGN	[^Citation7]
♀60 ys	AS	ETN	RBC,WBC, casts, ↑ u-Prot (10 g/day)	Membranous GN	[^Citation8]
♂ 61	AS	ETN	RBC, ↑ s-Cr, ↑ u-Prot	IgA and C3 mGN (HSP)	[^Citation9]
♂37 ys	AS	INF	RBC, ↑ s-Cr, ↑ u-Prot (1.7 g/day)	IgA MGN	[^Citation10]
♂42 ys	AS	ADA	↑ s-Cr	Granulomatous interstitial nephritis	[^Citation11]
♀ 40 ys	AS	ETN/INF	↑ u-Prot, RBC	FSGS	[^Citation12]
♂47 ys	AS	ADA	RBC, ↑ s-Cr, ↑ u-Prot (2.6 g/day)	NCGN	[^Citation13]
♂ 57 ys	PsA	ETN	↑ s-Cr, ↑ u-Prot, RBC	-	[^Citation14]
♂ 29 ys	PsA	ADA	↑ u-Prot	Mesangial GN	[^Citation6]

Note: **Anti TNF administration refers to one, or two agents with the second one presented being the most recent.

Abbreviations: ETN, etanercept; ADA, adalimumab; INF, infliximab; GLM, golimumab; RBC, red blood cells; WBC, white blood cells; ↑ S-Cr, increased serum creatinine; ↑ U-Prot, increased proteinuria; MGN, membranous glomerulonephritis; NCGN, necrotizing crescentic glomerulonephritis; mGN, mesangial glomerulonephritis; HSP, Henoch–Shönlein purpura; FSGS, focal segmental glomerulosclerosis.

Figure 1 A proposed decision tree on the approach of the patient with SpA and renal involvement.

Davide D, Marta P, Antonella B, et al. Double glomerulonephritis in a patient with ankylosing spondylitis treated with biologic agent: extrarticolar involvement or anti-tumor necrosis factor alpha injury? A case-based review. Clin Med Insights Case Rep. 2020;13. doi:10.1177/1179547620974672

 Web of Science ®Google Scholar

Rolle AS, Zimmermann B, Poon SH. Etanercept-induced henoch-schönlein purpura in a patient with ankylosing spondylitis. J Clin Rheumatol. 2013;19:90–93. doi:10.1097/RHU.0b013e3182863027

 Web of Science ®Google Scholar

Kaushik P, Rahmani M, Ellison W. Membranous glomerulonephritis with the use of etanercept in ankylosing spondylitis. Ann Pharmacother. 2011;45:1585. doi:10.1345/aph.1Q492

 Google Scholar

Jacquet A, Francois H, Frangie C, et al. IgA nephropathy associated with ankylosing spondylitis is not controlled by infliximab therapy. Nephrol Dial Transplant. 2009;24:3540–3542. doi:10.1093/ndt/gfp314

 Web of Science ®Google Scholar

Korsten P, Sweiss NJ, Nagorsnik U, et al. Drug-induced granulomatous interstitial nephritis in a patient with ankylosing spondylitis during therapy with adalimumab. Am J Kidney Dis. 2010;56:e17–e21. doi:10.1053/j.ajkd.2010.08.019

 PubMed Web of Science ®Google Scholar

Yarkan Tuğsal H, Zengin B, Kenar G, et al. Infliximab-associated focal segmental glomerulosclerosis in a patient with ankylosing spondylitis. Rheumatol Int. 2019;39:561–567. doi:10.1007/s00296-019-04241-8

 Web of Science ®Google Scholar

Tosovský M, Bradna P, Laco J, Podhola M, Soukup T, Brozík J. Case 1-2012: ANCA associated glomerulonephritis in combination with IgG4-positive mediastinal mass in a patient with ankylosing spondylitis treated with TNF alpha inhibitors. Acta Medica (Hradec Kralove). 2012;55:42–46. doi:10.14712/18059694.2015.74

 Google Scholar

Lee A, Kasama R, Evangelisto A, Elfenbein B, Falasca G. Henoch-Schönlein purpura after etanercept therapy for psoriasis. J Clin Rheumatol. 2006;12:249–251. doi:10.1097/01.rhu.0000239901.34561.5e

 PubMed Web of Science ®Google Scholar

Piga M, Chessa E, Ibba V, et al. Biologics-induced autoimmune renal disorders in chronic inflammatory rheumatic diseases: systematic literature review and analysis of a monocentric cohort. Autoimmun Rev. 2014;13:873–879. doi:10.1016/j.autrev.2014.05.005

 PubMed Web of Science ®Google Scholar