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. 2001 Apr;60(4):327–331. doi: 10.1136/ard.60.4.327

A prospective study of renal disease in patients with early rheumatoid arthritis

Y Koseki 1, C Terai 1, M Moriguchi 1, M Uesato 1, N Kamatani 1
PMCID: PMC1753620  PMID: 11247860

Abstract

OBJECTIVES—This prospective study was designed to clarify the frequency, causes, and clinical course of renal disease in patients with early rheumatoid arthritis (RA).
METHODS—235 patients (185 women, mean age 49.4 years) with early RA of less than one year's duration were enrolled and assessed monthly. Proteinuria was defined as a positive dipstick result and microscopic haematuria was defined as the presence of ⩾5 red blood cells per high power field. Urinary abnormalities lasting three months or longer were defined as persistent abnormalities.
RESULTS—At entry, 40 patients exhibited haematuria, two had a raised serum creatinine concentration, and none had proteinuria. During the observation period (average 42 months), persistent haematuria was found in 43, persistent proteinuria in 17, and a raised serum creatinine concentration in 14 patients. Persistent proteinuria was caused by drugs in 14 of 17 patients and disappeared in most cases. Risk factors for drug induced proteinuria included a raised C reactive protein and erythrocyte sedimentation rate and age over 50 at entry. Drugs resulted in a raised serum creatinine concentration in eight of 14 patients. The incidence of haematuria at entry did not differ among patients who had been treated with non-steroidal anti-inflammatory drugs, disease modifying antirheumatic drugs, or no drugs. In some patients with isolated haematuria, the haematuria appeared when the activity of RA was high and resolved when it was low.
CONCLUSIONS—This study suggests that a raised serum creatinine concentration or persistent proteinuria in patients with early RA is predominantly drug related whereas, in contrast, isolated haematuria is more directly associated with the activity of the disease process.



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Selected References

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  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Banfi G., Imbasciati E., Guerra L., Mihatsch M. J., Ponticelli C. Extracapillary glomerulonephritis with necrotizing vasculitis in D-penicillamine-treated rheumatoid arthritis. Nephron. 1983;33(1):56–60. doi: 10.1159/000182906. [DOI] [PubMed] [Google Scholar]
  3. Barbour V. M., Williams P. F. Nephrotic syndrome associated with sulphasalazine. BMJ. 1990 Oct 6;301(6755):818–818. doi: 10.1136/bmj.301.6755.818-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boers M., Croonen A. M., Dijkmans B. A., Breedveld F. C., Eulderink F., Cats A., Weening J. J. Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies. Ann Rheum Dis. 1987 Sep;46(9):658–663. doi: 10.1136/ard.46.9.658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Boers M., Dijkmans B. A., Breedveld F. C., Camps J. A., Chang P. C., van Brummelen P., Pauwels E. K., Cats A. Subclinical renal dysfunction in rheumatoid arthritis. Arthritis Rheum. 1990 Jan;33(1):95–101. doi: 10.1002/art.1780330113. [DOI] [PubMed] [Google Scholar]
  6. Boers M. Renal disorders in rheumatoid arthritis. Semin Arthritis Rheum. 1990 Aug;20(1):57–68. doi: 10.1016/0049-0172(90)90095-w. [DOI] [PubMed] [Google Scholar]
  7. Bourke B. E., Woodrow D. F., Scott J. T. Proteinuria in rheumatoid arthritis--drug-induced or amyloid? Ann Rheum Dis. 1981 Jun;40(3):240–244. doi: 10.1136/ard.40.3.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Calvo-Alén J., De Cos M. A., Rodríguez-Valverde V., Escallada R., Florez J., Arias M. Subclinical renal toxicity in rheumatic patients receiving longterm treatment with nonsteroidal antiinflammatory drugs. J Rheumatol. 1994 Sep;21(9):1742–1747. [PubMed] [Google Scholar]
  9. Dieppe P. A., Doyle D. V., Burry H. C., Tucker S. M. Renal disease in rheumatoid arthritis. Br Med J. 1976 Mar 13;1(6010):611–612. doi: 10.1136/bmj.1.6010.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gertz M. A., Kyle R. A. Secondary systemic amyloidosis: response and survival in 64 patients. Medicine (Baltimore) 1991 Jul;70(4):246–256. [PubMed] [Google Scholar]
  11. Hall C. L., Fothergill N. J., Blackwell M. M., Harrison P. R., MacKenzie J. C., MacIver A. G. The natural course of gold nephropathy: long term study of 21 patients. Br Med J (Clin Res Ed) 1987 Sep 26;295(6601):745–748. doi: 10.1136/bmj.295.6601.745. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hall C. L., Jawad S., Harrison P. R., MacKenzie J. C., Bacon P. A., Klouda P. T., MacIver A. G. Natural course of penicillamine nephropathy: a long term study of 33 patients. Br Med J (Clin Res Ed) 1988 Apr 16;296(6629):1083–1086. doi: 10.1136/bmj.296.6629.1083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Helin H. J., Korpela M. M., Mustonen J. T., Pasternack A. I. Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arthritis Rheum. 1995 Feb;38(2):242–247. doi: 10.1002/art.1780380213. [DOI] [PubMed] [Google Scholar]
  14. Helin H., Korpela M., Mustonen J., Pasternack A. Mild mesangial glomerulopathy--a frequent finding in rheumatoid arthritis patients with hematuria or proteinuria. Nephron. 1986;42(3):224–230. doi: 10.1159/000183671. [DOI] [PubMed] [Google Scholar]
  15. Hirano T., Matsuda T., Turner M., Miyasaka N., Buchan G., Tang B., Sato K., Shimizu M., Maini R., Feldmann M. Excessive production of interleukin 6/B cell stimulatory factor-2 in rheumatoid arthritis. Eur J Immunol. 1988 Nov;18(11):1797–1801. doi: 10.1002/eji.1830181122. [DOI] [PubMed] [Google Scholar]
  16. Hordon L. D., Sellars L., Morley A. R., Wilkinson R., Thompson M., Griffiths I. D. Haematuria in rheumatoid arthritis: an association with mesangial glomerulonephritis. Ann Rheum Dis. 1984 Jun;43(3):440–443. doi: 10.1136/ard.43.3.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Horii Y., Muraguchi A., Iwano M., Matsuda T., Hirayama T., Yamada H., Fujii Y., Dohi K., Ishikawa H., Ohmoto Y. Involvement of IL-6 in mesangial proliferative glomerulonephritis. J Immunol. 1989 Dec 15;143(12):3949–3955. [PubMed] [Google Scholar]
  18. Houssiau F. A., Devogelaer J. P., Van Damme J., de Deuxchaisnes C. N., Van Snick J. Interleukin-6 in synovial fluid and serum of patients with rheumatoid arthritis and other inflammatory arthritides. Arthritis Rheum. 1988 Jun;31(6):784–788. doi: 10.1002/art.1780310614. [DOI] [PubMed] [Google Scholar]
  19. Israel A. R., Susin M., Vaughan E. D., Jr Microhematuria associated with gold therapy: evaluation and management. J Urol. 1982 Mar;127(3):477–478. doi: 10.1016/s0022-5347(17)53873-2. [DOI] [PubMed] [Google Scholar]
  20. Kimberly R. P., Gill J. R., Jr, Bowden R. E., Keiser H. R., Plotz P. H. Elevated urinary prostaglandins and the effects of aspirin on renal function in lupus erythematosus. Ann Intern Med. 1978 Sep;89(3):336–341. doi: 10.7326/0003-4819-89-3-336. [DOI] [PubMed] [Google Scholar]
  21. Korpela M., Mustonen J., Heikkinen A., Helin H., Pasternack A. Isolated microscopic hematuria in patients with rheumatoid arthritis compared with age and sex matched controls. A population based study. J Rheumatol. 1995 Mar;22(3):427–431. [PubMed] [Google Scholar]
  22. Korpela M., Mustonen J., Pasternack A., Helin H. Mesangial glomerulopathy in rheumatoid arthritis patients. Clinical follow-up and relation to antirheumatic therapy. Nephron. 1991;59(1):46–50. doi: 10.1159/000186516. [DOI] [PubMed] [Google Scholar]
  23. Leonard P. A., Bienz S. R., Clegg D. O., Ward J. R. Hematuria in patients with rheumatoid arthritis receiving gold and D-penicillamine. J Rheumatol. 1987 Feb;14(1):55–59. [PubMed] [Google Scholar]
  24. Lourie S. H., Denman S. J., Schroeder E. T. Association of renal papillary necrosis and ankylosing spondylitis. Arthritis Rheum. 1977 May;20(4):917–921. doi: 10.1002/art.1780200403. [DOI] [PubMed] [Google Scholar]
  25. Mutru O., Laakso M., Isomäki H., Koota K. Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1797–1799. doi: 10.1136/bmj.290.6484.1797. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nakano M., Ueno M., Nishi S., Shimada H., Hasegawa H., Watanabe T., Kuroda T., Sato T., Maruyama Y., Arakawa M. Analysis of renal pathology and drug history in 158 Japanese patients with rheumatoid arthritis. Clin Nephrol. 1998 Sep;50(3):154–160. [PubMed] [Google Scholar]
  27. Nived O., Sturfelt G., Westling H., White T. Is serum creatinine concentration a reliable index of renal function in rheumatic diseases? Br Med J (Clin Res Ed) 1983 Feb 26;286(6366):684–685. doi: 10.1136/bmj.286.6366.684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Pirson Y., van Ypersele de Strihou C. Renal side effects of nonsteroidal antiinflammatory drugs: clinical relevance. Am J Kidney Dis. 1986 Nov;8(5):338–344. doi: 10.1016/s0272-6386(86)80108-1. [DOI] [PubMed] [Google Scholar]
  29. ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
  30. Ramirez G., Lambert R., Bloomer H. A. Renal pathology in patients with rheumatoid arthritis. Nephron. 1981;28(3):124–126. doi: 10.1159/000182132. [DOI] [PubMed] [Google Scholar]
  31. SORENSEN A. W. THE KIDNEY FUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS IN RELATION TO THE COMMENCEMENT OF THE DISEASE. VI. Acta Rheumatol Scand. 1964;10:11–28. doi: 10.3109/rhe1.1964.10.issue-1-4.02. [DOI] [PubMed] [Google Scholar]
  32. Sadjadi S. A., Seelig M. S., Berger A. R., Milstoc M. Rapidly progressive glomerulonephritis in a patient with rheumatoid arthritis during treatment with high-dosage D-penicillamine. Am J Nephrol. 1985;5(3):212–216. doi: 10.1159/000166936. [DOI] [PubMed] [Google Scholar]
  33. Saito T., Nishi S., Karasawa R., In H., Hayashi H., Ueno M., Ogino S., Sugiyama N., Suzuki S., Maruyama Y. An ultrastructural study of glomerular basement membrane in rheumatoid arthritis patients with urinary abnormalities. Clin Nephrol. 1995 Jun;43(6):360–367. [PubMed] [Google Scholar]
  34. Suematsu S., Matsuda T., Aozasa K., Akira S., Nakano N., Ohno S., Miyazaki J., Yamamura K., Hirano T., Kishimoto T. IgG1 plasmacytosis in interleukin 6 transgenic mice. Proc Natl Acad Sci U S A. 1989 Oct;86(19):7547–7551. doi: 10.1073/pnas.86.19.7547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Suzuki A., Ohosone Y., Obana M., Mita S., Matsuoka Y., Irimajiri S., Fukuda J. Cause of death in 81 autopsied patients with rheumatoid arthritis. J Rheumatol. 1994 Jan;21(1):33–36. [PubMed] [Google Scholar]
  36. Unsworth J., Sturman S., Lunec J., Blake D. R. Renal impairment associated with non-steroidal anti-inflammatory drugs. Ann Rheum Dis. 1987 Mar;46(3):233–236. doi: 10.1136/ard.46.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Yoshida A., Morozumi K., Suganuma T., Sugito K., Ikeda M., Oikawa T., Fujinami T., Takeda A., Koyama K. Clinicopathological findings of bucillamine-induced nephrotic syndrome in patients with rheumatoid arthritis. Am J Nephrol. 1991;11(4):284–288. doi: 10.1159/000168323. [DOI] [PubMed] [Google Scholar]

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