Muthukumar Periyasamy, Dhanapriya Jeyachandran, Gopalakrishnan Natarajan, Dineshkumar Thanigachalam, Sakthirajan Ramanathan, Balasubramaniyan T
Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Saudi J Kidney Dis Transpl. 2017 Jan-Feb;28(1):44-50. doi: 10.4103/1319-2442.198118.
The most common causes of renal disease in rheumatoid arthritis (RA) are glomerulonephritis (GN), amyloidosis, tubulo-interstitial nephritis, and drug toxicity. Our aim was to evaluate the clinicopathologic correlation of renal lesions and to assess the course and prognosis of renal disease in patients with RA. We conducted a prospective observational study in all adult patients with RA between July 2010 and June 2015. The total number of patients studied was 90, with a female:male ratio of 2.3:1. Mean follow-up duration was 30 ± 6.5 months. About 54 patients (60%) were asymptomatic. The most common symptom was edema legs (30%), followed by oliguria (10%). About 18 patients (20%) presented with the nephrotic syndrome, 15 patients (16.6%) with nephritic syndrome, and 30 (33%) with asymptomatic urinary abnormalities. Chronic kidney disease (CKD) was seen in 48 of 90 patients (53%).The most common renal pathology noted was mesangioproliferative GN followed by membranous nephropathy (MN). IgM with C3 deposits was the most common immunofluorescence pattern observed. Among the patients who had glomerular diseases, complete remission was seen in nine patients, partial remission in 15, and persistent proteinuria in 14. Duration of RA and a high erythrocyte sedimentation rate correlated significantly with persistent proteinuria. Only one patient in the glomerular disease group progressed to dialysis-dependent renal failure. On followup, 11 out of 48 CKD patients showed a significant decrease in estimated glomerular filtration rate and worsened to the next stage of CKD. Renal disease in RA presents with varied renal pathology. MN was seen frequently and was not associated with gold or penicillamine usage. Relatively high incidence of CKD was noted. Hence, it is important to monitor renal function abnormalities periodically in these patients.
类风湿关节炎（RA）患者肾病的最常见病因是肾小球肾炎（GN）、淀粉样变性、肾小管间质性肾炎和药物毒性。我们的目的是评估肾脏病变的临床病理相关性，并评估RA患者肾病的病程和预后。我们对2010年7月至2015年6月期间所有成年RA患者进行了一项前瞻性观察研究。研究的患者总数为90例，女性与男性的比例为2.3:1。平均随访时间为30±6.5个月。约54例患者（60%）无症状。最常见的症状是下肢水肿（30%），其次是少尿（10%）。约18例患者（20%）表现为肾病综合征，15例患者（16.6%）表现为肾炎综合征，30例患者（33%）表现为无症状性尿液异常。90例患者中有48例（53%）出现慢性肾脏病（CKD）。最常见的肾脏病理表现为系膜增生性GN，其次是膜性肾病（MN）。观察到的最常见免疫荧光模式是IgM伴C3沉积。在患有肾小球疾病的患者中，9例完全缓解，15例部分缓解，14例持续蛋白尿。RA病程和高红细胞沉降率与持续蛋白尿显著相关。肾小球疾病组中只有1例患者进展为依赖透析的肾衰竭。随访时，48例CKD患者中有11例估计肾小球滤过率显著下降并恶化至CKD的下一阶段。RA患者的肾病表现出多种肾脏病理类型。MN较为常见，且与金制剂或青霉胺的使用无关。注意到CKD的发病率相对较高。因此，定期监测这些患者的肾功能异常很重要。
