Department of Nephrology and Rheumatology, University Medicine Göttingen, Göttingen, Germany.
Am J Kidney Dis. 2010 Dec;56(6):e17-21. doi: 10.1053/j.ajkd.2010.08.019. Epub 2010 Oct 25.
Tumor necrosis factor α (TNF-α) inhibitors are used in the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn disease, ankylosing spondylitis, and juvenile idiopathic arthritis. Use of TNF inhibitors is associated with the induction of autoimmunity (systemic lupus erythematosus, vasculitis, psoriasis, and sarcoidosis/sarcoid-like granulomas). We report a case of interstitial granulomatous nephritis in a patient with ankylosing spondylitis after 18 months of treatment with adalimumab. Previously reported cases of sarcoid-like reactions secondary to the use of TNF-α inhibitors involved the liver, lung, lymph nodes, central nervous system, and skin. Granulomatous nephritis after adalimumab treatment has not been described. Close observation of patients undergoing treatment with TNF inhibitors for evolving signs and symptoms of autoimmunity is required. Organ involvement is unpredictable, which makes correct diagnosis and management extremely challenging.
肿瘤坏死因子 α（TNF-α）抑制剂被用于治疗类风湿关节炎、银屑病、银屑病关节炎、克罗恩病、强直性脊柱炎和幼年特发性关节炎。使用 TNF 抑制剂与自身免疫的诱导有关（系统性红斑狼疮、血管炎、银屑病和结节病/类结节病样肉芽肿）。我们报告了一例阿达木单抗治疗 18 个月后发生的强直性脊柱炎间质性肉芽肿性肾炎。先前报道的 TNF-α抑制剂引起的类肉瘤样反应的病例涉及肝脏、肺、淋巴结、中枢神经系统和皮肤。阿达木单抗治疗后发生的肉芽肿性肾炎尚未见报道。需要密切观察接受 TNF 抑制剂治疗的患者是否出现自身免疫相关的进行性体征和症状。器官受累是不可预测的，这使得正确的诊断和管理极具挑战性。
