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Banker H, Prasad P, Kumar A, Mahajan S, Kumar R, Batra V. An Abysmal Quadrad: A Rare Case of Ankylosing Spondylitis, Ulcerative Colitis, and Takayasu Aortoarteritis Complicated by Secondary Renal Amyloidosis. Indian J Nephrol 2024; 34:267-269. [PMID: 39114404 PMCID: PMC11302127 DOI: 10.4103/ijn.ijn_294_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2024] Open
Abstract
Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis that typically manifests in young males and may present with extra-articular manifestations. Takayasu aortoarteritis (TA) is a large vessel vasculitis that predominantly affects young and middle-aged females. Despite the limited number of studies examining the potential association between these two diseases, we report a unique case of an individual with ankylosing spondylitis and ulcerative colitis who subsequently developed Takayasu aortoarteritis. This progression ultimately led to the development of secondary renal amyloidosis, attributed to a combination of inflammatory pathologies.
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Affiliation(s)
- Himanshi Banker
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Adarsh Kumar
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Sanjiv Mahajan
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Rajesh Kumar
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Vineeta Batra
- Department of Pathology, G. B. Pant Institute of Post-Graduation and Research, New Delhi, Delhi, India
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Leong PY, Shih PC, Huo AP. Is low-dose tumor necrosis factor inhibitor effective and safe in patients with ankylosing spondylitis flare-up after renal transplantation? A case report and literature review. Int J Rheum Dis 2024; 27:e14877. [PMID: 37602749 DOI: 10.1111/1756-185x.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Rheumatic diseases, the immunosuppressant drugs used after solid organ transplantation to prevent graft rejection, and the biologics used for controlling rheumatic disease, especially tumor necrosis factor inhibitors (TNFi)-all of these could increase the risk of malignancy. The roles of biologics for disease control in rheumatic disease patients after kidney transplantation (KT) are not well established because only a few cases are reported, and the possibility of increasing infection and malignancy rates. Here, we present the first case of ankylosing spondylitis (AS) successfully treated with low-dose TNFi for disease activity flare-up 5 months after KT and review the literature to see whether the use of biologics, especially TNFi, in AS patients with disease activity flare-ups after receiving KT is effective and safe.
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Affiliation(s)
- Pui-Ying Leong
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Cheng Shih
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - An-Ping Huo
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Wang XF, Duan SB, He J, Wu X, Wu T. Causal effects of rheumatoid arthritis or ankylosing spondylitis on membranous nephropathy: a two-sample Mendelian randomization study. Clin Kidney J 2023; 16:2605-2613. [PMID: 38046019 PMCID: PMC10689137 DOI: 10.1093/ckj/sfad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Membranous nephropathy (MN) is the leading cause of adult-onset nephrotic syndrome, with primary MN of unclear cause accounting for 80% of cases. Retrospective clinical research reported that MN occurring in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients was triggered by nephrotoxic drugs or of unknown cause. However, whether RA or AS itself increases the risk of developing MN is unknown. Methods We conducted mendelian randomization (MR) analysis to evaluate the causal effects of RA or AS on MN using genome-wide association study (GWAS) statistics. The inverse variance weighted (IVW) method was the primary analysis, and several supplementary analyses and sensitivity analyses were performed to test the causal estimates. Results We obtained 30 valid instrumental variables (IVs) of RA and 16 valid IVs of AS from large-scale open-access GWASs. The genetically predicted RA significantly increased the risk of MN [IVW odds ratios (OR) = 1.327, 95% confidence interval (CI) = (1.124, 1.565), P = 8.051 × 10-4]. Three supplementary MR analyses provided the consistent positive causal effect of RA on MN (all P < 0.05). No horizontal pleiotropy was detected by MR Egger intercept analysis (P = 0.411). However, the genetically predicted AS had no causal effect on MN by IVW and supplementary analysis (all P > 0.05). Conclusions Genetically predicted RA could increase the risk of MN, but genetically predicted AS was not associated with MN. Screening for kidney involvement in RA patients should be noted, and active treatment of RA will reduce the public health burden of MN.
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Affiliation(s)
- Xiu-Fen Wang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Jian He
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xi Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
| | - Ting Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China
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Boussaid S, Tbini H, Rekik S, Mami I, Ben Fatma L, Jammali S, Bargaoui H, Sahli H, Rais L, Zouaghi MK, Elleuch M. Focal Segmental Glomerulosclerosis and Hyalinosis in a Patient with Spondyloarthritis: A Rare Renal Involvement Case Report. Mediterr J Rheumatol 2023; 34:257-261. [PMID: 37654640 PMCID: PMC10466365 DOI: 10.31138/mjr.34.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 09/02/2023] Open
Abstract
Background During its course, spondyloarthritis (SpA) may be associated with extra-articular manifestations affecting several organs. Renal involvement is one of the most common extra-articular manifestations and is dominated by secondary amyloidosis (AA), immunoglobulin A (IgA) nephropathy, and urolithiasis. Other nephropathies such as Focal segmental glomerulosclerosis and hyalinosis (FSGS) are less common and are limited to few case reports. Case We report the case of a patient followed for axial SpA, who consulted, after being lost to follow-up for 3 years, for elevated blood pressure and edema of both lower limbs associated with an hydrocele and bilateral pleural effusion. Biological examinations showed hypoproteinemia, hypoalbuminemia, and proteinuria. In this context of nephrotic syndrome, the diagnosis of FSGS was confirmed by renal biopsy. Furthermore, the etiological investigation ruled out the causes of secondary FSGS. Conclusion Renal involvement is a sign of severity in SpA. Its detection and management should be part of the overall management of SpA.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Houssem Tbini
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ikram Mami
- Nephrology, Dialysis, and Renal Transplantation Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Lilia Ben Fatma
- Nephrology, Dialysis, and Renal Transplantation Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hela Bargaoui
- Nephrology, Dialysis, and Renal Transplantation Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Lamia Rais
- Nephrology, Dialysis, and Renal Transplantation Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mohamed Karim Zouaghi
- Nephrology, Dialysis, and Renal Transplantation Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Märker-Hermann E. [Renal manifestations in rheumatoid arthritis and spondylarthritis]. Z Rheumatol 2022; 81:845-850. [PMID: 36264330 DOI: 10.1007/s00393-022-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
As systemic diseases it is not uncommon for inflammatory rheumatic diseases to exhibit renal involvement. In contrast to connective tissue diseases and vasculitis, in rheumatoid arthritis and spondylarthritis direct inflammatory manifestations in the sense of glomerulonephritis (GN) and autoimmune interstitial nephritis are rare. In these groups of diseases renal biopsies usually show mesangial proliferative GN and IgA nephropathy or less commonly membranous GN. These and secondary amyloid A (AA) amyloidosis are regularly associated with longer lasting disease activity and a poor prognosis; however, clinically more frequent and more relevant are other sequelae of chronic systemic inflammation, namely endothelial function disorder and the premature development of atherosclerosis, resulting in progressive kidney failure. This is accompanied by the undesired effects of antirheumatic treatment and renal complications of comorbidities.
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Affiliation(s)
- Elisabeth Märker-Hermann
- Klinik Innere Medizin IV (Rheumatologie, klinische Immunologie, Nephrologie), Helios Dr. Horst Schmidt Kliniken Wiesbaden GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland.
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Rodrigues AC, Marques JC, Reis M, Góis M, Sousa H, Nolasco F. Kidney Disease in Ankylosing Spondylitis: a case series and review of the literature. J Bras Nefrol 2022; 45:36-44. [PMID: 35579342 PMCID: PMC10139727 DOI: 10.1590/2175-8239-jbn-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Background Kidney disease is a rare manifestation of ankylosing spondylitis (AS) and its pathological alterations remain poorly described. The aim of this study was to investigate the clinical presentation and pathological alterations on kidney biopsy of AS patients and review and discuss the current literature on the issue. Methods: We retrospectively studied the clinical presentation and kidney pathological alterations of 15 Caucasian AS patients submitted to kidney biopsy between October 1985 and March 2021. Results: Patients were predominantly male (66.7%) with median age at the time of kideney biopsy of 47 years [IQR 34 - 62]. Median serum creatinine at presentation was 1.3 mg/dL [IQR 0.9 - 3] and most patients also had either proteinuria (85.7%) and/or hematuria (42.8%). The most common indication for kidney biopsy was nephrotic syndrome (33.3%), followed by acute or rapidly progressive kidney injury (20%) and chronic kidney disease of unknown etiology (20%). Chronic interstitial nephritis (CIN) (n=3) and AA amyloidosis (n=3) were the most common diagnosis. Others included IgA nephropathy (IgAN) (n=2), focal segmental glomerulosclerosis (n=2), membranous nephropathy (n=1), and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN)(n=1). Conclusions: We present one of the largest series of biopsy-proven kidney disease in Caucasian AS patients. We found a lower prevalence of IgAN than previously reported in Asian cohorts. We found a higher prevalence of CIN and a lower prevalence of AA amyloidosis than that described in previous series of Caucasian patients. We also present the first case of AS-associated IC-MPGN.
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Affiliation(s)
| | | | - Marina Reis
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Mário Góis
- Hospital Curry Cabral, Portugal; Hospital Curry Cabral, Portugal
| | - Helena Sousa
- Hospital Curry Cabral, Portugal; Hospital Curry Cabral, Portugal
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