Glomerulonephritis in patients with rheumatoid arthritis (RA). Report of five cases and review of the literature.
We reported five cases of glomerulonephritis developed in the course of rheumatoid arthritis (RA), which had no apparent relation with therapeutic agents. Systemic angiitis was observed in patient 1 and overlapping of systemic lupus erythematosus (SLE) with RA was implied in patient 2, while the other three patients did not show these changes. Renal biopsies were performed in all of the cases and glomerular deposition of immune complexes was suggested by both the immunofluorescent and electron microscopic findings, though the amount was variable. Furthermore, cases of glomerulonephritis in patients with RA were reviewed in the literature and classified into three groups: occurring in association with angiitis, overlapping with SLE or other collagen diseases, and developing without the above two factors. Group 3 was further divided into two subgroups according to immunologic abnormalities. All cases included in the three groups can be regarded as glomerulonephritis of RA. The cases of group 2, however, can more preferentially be considered to be caused by SLE or some other collagen disease that has overlapped with RA. Deposition of immune complexes was suggested in most of the cases examined with immunofluorescence. Various changes were seen in the glomerulonephritis of RA presented here (patients 1, 3, 4, and 5) and reviewed in the literature (groups 1 and 3). Immune complexes might be involved in the pathogenesis of glomerulitis.
D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D000936:Antigen-Antibody Complex / Q000032:analysis; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology; D001707:Biopsy, Needle; D003095:Collagen Diseases / Q000150:complications; D005069:Evaluation Studies as Topic; D005260:Female; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000145:classification / Q000209:etiology* / Q000276:immunology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008854:Microscopy, Electron; D008875:Middle Aged; D014657:Vasculitis / Q000150:complications
D000974:Antibodies, Antinuclear; D000936:Antigen-Antibody Complex