A Case of Adalimumab-Induced Granulomatous Interstitial Nephritis.

Adalimumab is a monoclonal antibody targeting tumour necrosis factor-alpha (TNF-alpha) and is used for the treatment of numerous autoimmune conditions. There is a paucity of evidence linking adalimumab with granulomatous interstitial nephritis (GIN). We describe a renal biopsy-proven case of GIN secondary to adalimumab therapy. A 52-year-old gentleman with a background of psoriatic arthropathy was referred to the nephrology department by his general practitioner with a progressive decline in renal function over 18 months after initiating adalimumab. A renal biopsy confirmed tubulointerstitial nephritis with focal aggregates of histiocytes, organized as granulomata. Screening for other GIN causing aetiology, including tuberculosis (TB) and sarcoidosis, was negative. Adalimumab was withheld, leading to a slow improvement in renal function over a course of six months. It is essential to monitor renal function when administrating anti-TNF alpha agents as they can rarely paradoxically cause autoimmune reactions such as GIN seen in our case.