Rheumatoid arthritis and membranous glomerulonephritis: a role for immune complex dissociative techniques.
Although controversial, several reports have linked rheumatoid arthritis (RA) with membranous glomerulonephritis (MGN). In none of these studies was an infectious etiology such as hepatitis B virus (HBV) thoroughly pursued. We evaluated a patient with classic RA and MGN unassociated with nephrotoxic drugs. Although negative by routine serological methods, hepatitis B surface antigen was eventually demonstrated in the serum, using immune complex dissociative techniques, and in the renal glomeruli, using tissue immunofluorescence. A review of the literature provides no conclusive evidence for a causal relationship of RA to MGN. The renal pathogenic potential of HBV, however, is well documented. Future use of immune complex dissociative techniques and tissue immunofluorescence may be of value in clarifying otherwise unexplained MGN in the setting of RA.
D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis*; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001485:Basement Membrane / Q000276:immunology; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007668:Kidney / Q000648:ultrastructure; D007678:Kidney Glomerulus / Q000276:immunology; D008297:Male; D008854:Microscopy, Electron
D000936:Antigen-Antibody Complex; D006514:Hepatitis B Surface Antigens