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Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience
KEY POINTS: This renal biopsy study documents clinical renal dysfunction and pathologic lesions encountered in patients after anti-TNFα therapy and compares them with similar patients without treatment. This study highlights the spectrum of autoimmune, serologic, and other kidney adverse effects of...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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American Society of Nephrology
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103359/ https://www.ncbi.nlm.nih.gov/pubmed/36706240 http://dx.doi.org/10.34067/KID.0000000000000063 |
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author | Usui, Joichi Salvatore, Steven P. Yamagata, Kunihiro Seshan, Surya V. |
author_facet | Usui, Joichi Salvatore, Steven P. Yamagata, Kunihiro Seshan, Surya V. |
author_sort | Usui, Joichi |
collection | PubMed |
description | KEY POINTS: This renal biopsy study documents clinical renal dysfunction and pathologic lesions encountered in patients after anti-TNFα therapy and compares them with similar patients without treatment. This study highlights the spectrum of autoimmune, serologic, and other kidney adverse effects of anti-TNFα therapy. Unrelated active or chronic renal lesions including amyloidosis secondary to the underlying systemic inflammatory states may be observed. BACKGROUND: Anti-TNFα inhibitors, as biological agents, are used in autoimmune inflammatory states, rheumatoid arthritis (RA), psoriatic arthritis (PA), and Crohn disease. They can induce autoimmune serologic responses and clinical disorders, including systemic vasculitis and lupus-like diseases, affecting the kidney. METHODS: Retrospective analysis of clinicopathologic features of kidney disease after anti-TNFα therapy (treatment group) from our renal biopsy files from 2000 to 2018 is conducted and compared with 106 patients without therapy (control group). RESULTS: Forty-eight patients using anti-TNFα agents had renal biopsies: RA in 30, PA six, Crohn disease six, RA and PA one, RA and Crohn disease one, and others four. Twenty received etanercept, 15 adalimumab, eight infliximab, and five two forms of agents manifesting new-onset nephritic syndrome or CKD, 17 with AKI and 16 nephrotic syndrome, with recent ANCA and/or lupus serology. The renal lesions were crescentic GN in eight, pauci-immune–type in five, and ANCA+ in five. Lupus or lupus-like nephritis was seen in six: International Society of Nephrology/Renal Pathology Society 2018 class II—2, class V—2, class III+V—1, and class IV+V—1, and concurrent fibrillary GN, scleroderma/thrombotic microangiopathy (TMA), and amyloidosis in three. Renal lesions unrelated to anti-TNFα therapy or underlying autoimmune disease were noted in 23 patients (e.g., diabetic nephropathy, interstitial nephritis, acute tubular injury, infection-related GN); immunoglobulin A nephropathy, renal sarcoidosis, and amyloid A amyloidosis were noted in five patients. TMA was recognized in five patients, one associated with scleroderma and one anti-phospholipid antibodies, and two had nephrotic syndrome secondary to podocytopathy. The control group was similar with higher number of immune-mediated GN, interstitial nephritis, and amyloidosis. CONCLUSION: The renal lesions during anti-TNFα therapy have an autoimmune basis such as ANCA and lupus or lupus-like disease, correlated with new-onset serology, while others were similar to those observed in the control group. Renal biopsy findings integrated with clinical features and therapy can identify the underlying pathophysiologic process for appropriate management. |
format | Online Article Text |
id | pubmed-10103359 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Society of Nephrology |
record_format | MEDLINE/PubMed |
spelling | pubmed-101033592023-08-03 Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience Usui, Joichi Salvatore, Steven P. Yamagata, Kunihiro Seshan, Surya V. Kidney360 Original Investigation KEY POINTS: This renal biopsy study documents clinical renal dysfunction and pathologic lesions encountered in patients after anti-TNFα therapy and compares them with similar patients without treatment. This study highlights the spectrum of autoimmune, serologic, and other kidney adverse effects of anti-TNFα therapy. Unrelated active or chronic renal lesions including amyloidosis secondary to the underlying systemic inflammatory states may be observed. BACKGROUND: Anti-TNFα inhibitors, as biological agents, are used in autoimmune inflammatory states, rheumatoid arthritis (RA), psoriatic arthritis (PA), and Crohn disease. They can induce autoimmune serologic responses and clinical disorders, including systemic vasculitis and lupus-like diseases, affecting the kidney. METHODS: Retrospective analysis of clinicopathologic features of kidney disease after anti-TNFα therapy (treatment group) from our renal biopsy files from 2000 to 2018 is conducted and compared with 106 patients without therapy (control group). RESULTS: Forty-eight patients using anti-TNFα agents had renal biopsies: RA in 30, PA six, Crohn disease six, RA and PA one, RA and Crohn disease one, and others four. Twenty received etanercept, 15 adalimumab, eight infliximab, and five two forms of agents manifesting new-onset nephritic syndrome or CKD, 17 with AKI and 16 nephrotic syndrome, with recent ANCA and/or lupus serology. The renal lesions were crescentic GN in eight, pauci-immune–type in five, and ANCA+ in five. Lupus or lupus-like nephritis was seen in six: International Society of Nephrology/Renal Pathology Society 2018 class II—2, class V—2, class III+V—1, and class IV+V—1, and concurrent fibrillary GN, scleroderma/thrombotic microangiopathy (TMA), and amyloidosis in three. Renal lesions unrelated to anti-TNFα therapy or underlying autoimmune disease were noted in 23 patients (e.g., diabetic nephropathy, interstitial nephritis, acute tubular injury, infection-related GN); immunoglobulin A nephropathy, renal sarcoidosis, and amyloid A amyloidosis were noted in five patients. TMA was recognized in five patients, one associated with scleroderma and one anti-phospholipid antibodies, and two had nephrotic syndrome secondary to podocytopathy. The control group was similar with higher number of immune-mediated GN, interstitial nephritis, and amyloidosis. CONCLUSION: The renal lesions during anti-TNFα therapy have an autoimmune basis such as ANCA and lupus or lupus-like disease, correlated with new-onset serology, while others were similar to those observed in the control group. Renal biopsy findings integrated with clinical features and therapy can identify the underlying pathophysiologic process for appropriate management. American Society of Nephrology 2023-01-27 /pmc/articles/PMC10103359/ /pubmed/36706240 http://dx.doi.org/10.34067/KID.0000000000000063 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Investigation Usui, Joichi Salvatore, Steven P. Yamagata, Kunihiro Seshan, Surya V. Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title | Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title_full | Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title_fullStr | Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title_full_unstemmed | Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title_short | Clinicopathologic Spectrum of Renal Lesions Following Anti-TNF-α Inhibitor Therapy: A Single Center Experience |
title_sort | clinicopathologic spectrum of renal lesions following anti-tnf-α inhibitor therapy: a single center experience |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103359/ https://www.ncbi.nlm.nih.gov/pubmed/36706240 http://dx.doi.org/10.34067/KID.0000000000000063 |
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