title: [Development of mesangial immunoglobulin IgA glomerulonephritis and p-ANCA positivity in a patient with psoriatic arthritis].
abstract: Tumor necrosis factor (TNF) inhibitors are widely used for the treatment of various rheumatic diseases. These agents may lead to development of systemic autoimmune diseases and renal complications. We report a patient with psoriatic arthritis and renal failure treated with two TNF inhibitors (Etanercept and then Adalimumab). After this treatment he developed proteinuria with nephrotic syndrome. A renal biopsy was performed highlighting GN with mesangial IgA deposits. Then he developed p-ANCA positivity. Following that, etanercept and adalimumab were stopped and a treatment by corticosteroids was initiated, but renal function decreased. Currently the patient is treated by haemodialysis. In our patient, the pathogenic role for anti-TNF therapy is suggested by the close temporal relationship with development of glomerular disease and by the improvement in proteinuria after drug withdrawal. However, the patient was treated once more with TNF agents, so he developed end stage renal disease.
authors.forename: Paola
authors.initials: P
authors.lastname: Nazzaro
authors.forename: Ruggiero
authors.initials: R
authors.lastname: Battaglia
authors.forename: Christian
authors.initials: C
authors.lastname: D'Altri
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Marangi
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Perniola
authors.forename: Angela
authors.initials: A
authors.lastname: Rodio
authors.forename: Francesco
authors.initials: F
authors.lastname: De Padova
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D000068800:Etanercept / Q000009:adverse effects; D005920:Glomerular Mesangium / Q000276:immunology; D005922:Glomerulonephritis, IGA / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D018501:Antirheumatic Agents; D015415:Biomarkers; D007070:Immunoglobulin A; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept; D008775:Methylprednisolone