Premužić Vedran, Padjen Ivan, Cerovec Mislav, Laganović Mario, Željković-Vrkić Tajana, Kos Jelena, Ćorić Marijana, Jelaković Bojan, Anić Branimir
Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10 000, Croatia.
Department of Immunology and Rheumatology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10 000, Croatia.
Case Rep Nephrol. 2020 Apr 20;2020:9480860. doi: 10.1155/2020/9480860. eCollection 2020.
IgA nephropathy (IgAN) is a rather uncommon complication of TNF-alpha inhibition with a range of findings such as asymptomatic microscopic/macroscopic hematuria or different degrees of proteinuria and could progress to end-stage renal disease. We are reporting three patients with longstanding rheumatoid arthritis (RA), which developed IgAN while receiving TNF-alpha inhibitors. All off our three patients had RA, which lasted 2-4 years, and none of them had a prior history of chronic kidney disease. Two patients were treated with adalimumab while one patient was treated with golimumab. Discontinuation of anti-TNF-alpha therapy and initiation of immunosuppressive therapy led to improvement in serologic abnormalities and renal function in two patients, while the third patient's 24-hour proteinuria was only partially reduced, which supports previous reports on TNF-alpha inhibitor induced autoimmunity. Two of our patients had previously been diagnosed with type 2 diabetes mellitus while the third patient developed diabetes years after the onset of IgAN. This is in line with the previously described association of IgAN and diabetes mellitus. To our best knowledge, this is the first report to analyze the development of IgAN as a potential consequence of anti-TNF-alpha therapy and its possible association with pretreatment or posttreatment diabetes.
IgA肾病（IgAN）是肿瘤坏死因子-α（TNF-α）抑制治疗一种相当罕见的并发症，有一系列表现，如无症状性镜下/肉眼血尿或不同程度的蛋白尿，且可能进展为终末期肾病。我们报告3例长期类风湿关节炎（RA）患者，在接受TNF-α抑制剂治疗时发生了IgA肾病。我们的3例患者均患有持续2 - 4年的类风湿关节炎，且均无慢性肾病病史。2例患者接受阿达木单抗治疗，1例患者接受戈利木单抗治疗。停用抗TNF-α治疗并开始免疫抑制治疗后，2例患者的血清学异常和肾功能有所改善，而第3例患者的24小时蛋白尿仅部分降低，这支持了既往关于TNF-α抑制剂诱导自身免疫的报道。我们的2例患者既往曾被诊断为2型糖尿病，而第3例患者在IgA肾病发病数年后患糖尿病。这与既往描述的IgA肾病与糖尿病的关联一致。据我们所知，这是首篇分析IgA肾病作为抗TNF-α治疗潜在后果的发生情况及其与治疗前或治疗后糖尿病可能关联的报告。
