Outcome and treatment of bucillamine-induced nephropathy.
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.
Hoshino
Junichi
J
Nephrology Center, Toranomon Hospital, Tokyo, Japan. hoshino@toranomon.gr.jp
Ubara
Yoshifumi
Y
Hara
Shigeo
S
Suwabe
Tatsuya
T
Sawa
Naoki
N
Tagami
Tetsuo
T
Katori
Hideyuki
H
Takemoto
Fumi
F
Hara
Shigeko
S
Takaichi
Kenmei
K