Nephrotic syndrome as a complication of anti-TNFalpha in a patient with rheumatoid arthritis.
We describe a patient with rheumatoid arthritis (RA) who developed a nephrotic syndrome during treatment with a fully human recombinant monoclonal antibody against TNFalpha (adalimumab, Humira, Abbott). The proteinuria disappeared spontaneously after cessation of anti-TNFalpha treatment and relapsed after rechallenge, pointing to anti-TNFalpha as the culprit. Although renal biopsy disclosed a membranous glomerulopathy, the clinical picture was more compatible with minimal lesion glomerulopathy. The pathogenesis of this side effect is not clear; several mechanisms could in theory lead to these abnormalities.
den Broeder
A A
AA
Department of Rheumatology, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. alfonsenellen.broeder@hccnet.nl
Assmann
K J M
KJ
van Riel
P L C M
PL
Wetzels
J F M
JF
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab