Glomerulonephritis in Two Patients with SpA Treated with TNF-α Blockers and a Review of the Literature

Renal failure or acute/chronic kidney damage may present as a clinical manifestation of rheumatic diseases. In addition treatment with DMARDs or biologic drugs may induce nephrotoxicity. In this case-based review, we present two patients with SpA under anti-TNF-alpha treatment admitted to our hospital because of renal failure and proteinuria. We review previously published yet isolated cases of TNF-alpha blocker-induced glomerular disease in patients with SpA. Renal manifestations are occasionally seen in patients with ankylosing spondylitis and psoriatic arthritis with IgA nephropathy being the most common of them. Anti-TNF-alpha agents although reportedly used for the treatment of glomerular nephropathy as a disease manifestation, they have been considered responsible for provoking renal damage in some cases. A diagnostic approach for patients with SpA treated with anti-TNF-alpha agents presenting with renal manifestations is proposed herein.

Automated summary

Renal failure can be a clinical manifestation of rheumatic diseases, and treatment with DMARDs or biologic drugs may lead to nephrotoxicity. Anti-TNF-alpha treatment in patients with SpA may induce renal failure, particularly in cases of IgA nephropathy. It is important to be cautious when using anti-TNF-alpha agents in patients with rheumatic diseases presenting with renal manifestations.