title: Outcome and treatment of bucillamine-induced nephropathy.
abstract: BACKGROUND
  Bucillamine (BCL), a treatment for rheumatoid arthritis, occasionally causes proteinuria. Renal specimens are reported to show segmental granular deposition of immunoglobulin G, associated with membranous nephropathy. Long-term course and optimal treatment have remained unknown, and were investigated here.
  
  
  METHODS
  We examined clinical records of 400 patients treated with BCL for rheumatoid arthritis, at our hospital from 1998 to 2003, finding 17 with proteinuria and biopsy-proven BCL-induced nephropathy.
  
  
  RESULTS
  In all 17 patients, proteinuria resolved without loss of renal function between 3 and 85 months after discontinuing BCL (14.1 +/- 3.4). The only factor influencing time to remission was pathologic stage of membranous nephropathy (stage I vs. stage II or III: 11.5 +/- 4.8 vs. 21.6 +/- 3.3 months; p = 0.02). Maximal proteinuria, total amount of BCL, BCL exposure time, and use of prednisolone or other immunosuppressant agents did not significantly influence time until remission.
  
  
  CONCLUSIONS
  The most important therapeutic step in treating BCL-induced nephropathy is to discontinue BCL. Prednisolone or other immunosuppressant agents might not be effective.
authors: Nephrology Center, Toranomon Hospital, Tokyo, Japan. hoshino@toranomon.gr.jp
authors: Junichi
authors: J
authors: Hoshino
authors: Yoshifumi
authors: Y
authors: Ubara
authors: Shigeo
authors: S
authors: Hara
authors: Tatsuya
authors: T
authors: Suwabe
authors: Naoki
authors: N
authors: Sawa
authors: Tetsuo
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authors: Tagami
authors: Hideyuki
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authors: Katori
authors: Fumi
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authors: Takemoto
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authors: Takaichi