Glomerulonephritis and Anti-TNF Therapy in Patients with Rheumatoid Arthritis: A Case Report and Literature Review

風濕性關節炎病患使用腫瘤壞死因子抑制劑治療與腎絲球腎病變的相關性：個案報告與文獻回顧

王貞懿(Chen-Yi Wang) ； 林瑞祥(Jui-Hsiang Lin) ； 王偉傑(Wei-Jie Wang) ； 鄭美華(Mei-Hua Cheng) ； 林明慧(Ming-Hui Lin)

《醫學與健康期刊》 8卷1期 (2019/03) Pp. 131-136

摘要

Herein we report a case of rheumatoid arthritis (RA) and immunoglobulin A nephropathy (IgAN) in a 68-year-old woman after 2 years of initiating etanercept (25mg weekly), a decoy receptor that binds to TNF. Because the patient presented progressively increased proteinuria associated with hematuria following etanercept initiation, we performed a renal biopsy to study the glomerulonephritis with mesangial and parietal IgA deposits. We suspected that IgAN was an adverse event related to use of etanercept. Proteinuria improved one year after etanercept was interrupted. The study period lasted from the time etanercept was started and the onset IgAN to improvement of glomerulonephritis after discontinuance of etanercept. No relapse of heavy proteinuria or hematuria was found in the RA patient during the recurrence free follow-up period.

關鍵字

Glomerulonephritis ； Rheumatoid arthritis ； Anti-TNF therapy ； Etanercept

並列摘要

我們報導一位68歲女性患者有類風濕性關節炎病史服用免疫抑制劑─恩博（etanercept）治療。由於蛋白尿狀況逐漸惡化並且伴隨血尿出現，因此建議執行腎臟切片，其結果顯示A型免疫球蛋白腎病（IgA nephropathy）。A型免疫球蛋白腎病被視為etanercept所產生的副作用。將藥物停止使用一年內，蛋白尿大幅改善。使用etanercept引起A型免疫球蛋白腎病的時間相當於停止使用etanercept後逐漸改善蛋白尿的時間，後續也沒有蛋白尿與血尿出現。

並列關鍵字

腎絲球腎病變 ； 風濕性關節炎 ； 腫瘤壞死因子抑制劑治療 ； 恩博

參考文獻

Korpela M, et al.: Mesangial glomerulonephritis as an extra-articular manifestation of rheumatoid arthritis. Br J Rheumatol 1997;36:1189-95.

Lea J, Cheek D, Thornley-Brown D, et al.: Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans. Am J Kidney Dis 2008; 51:732-40.

Zalevsky J, Secher T, Ezhevsky SA, et al.: Dominant-negative inhibitors of soluble TNF attenuate experimental arthritis without suppressing innate immunity to infection. J Immunol 2007;179:1872-83.

Catrina AI, Lampa J, Ernestam S, et al.: Anti-tumour necrosis factor (TNF)-alpha therapy (etanercept) downregulates serum matrix metalloproteinase (MMP)-3 and MMP-1 in rheumatoid arthritis. Rheumatology (Oxford) 2002;41:484-9.

Di Lernia V: IgA nephropathy during treatment with TNFalpha blockers: Could it be predicted? Med Hypotheses 2017;107:12-3.