Evaluation of renal lesions in rheumatoid arthritis with clinico-pathologic correlation.

Muthu Kumar, P (2013) Evaluation of renal lesions in rheumatoid arthritis with clinico-pathologic correlation. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Rheumatoid arthritis (RA) is a chronic crippling disease that affects various organ systems including the kidney. RA is the second most common rheumatologic problem next only to Systemic lupus erythematosus. Renal involvement in RA can be either due to the disease per se or due to the drugs used to treat the condition. RA can affect all the components of the kidney including the glomerulus, tubules, interstitium and the blood vessels. Most of the patients will be taking non-steroidal anti-inflammatory drugs, the potential renal toxicity of which is well known. Gold and penicillamine used in the management of RA has been very well known for their nephrotoxic potential by causing secondary membranous nephropathy. Some patients particularly those residing in the rural areas of Indian sub-continent might take indigenous medicines for the treatment of RA. If these indigenous medicines contain nephrotoxic substances, it adds up to the renal injury. Presence of other comorbidities like hypertension and atherosclerosis also affects the course and prognosis of renal disease in rheumatoid arthritis. Renal disease in RA is usually asymptomatic and detected only in laboratory investigations. Urine analysis for microalbuminuria, proteinuria, red blood cells and red blood cell cast and blood biochemistry including urea, creatinine and electrolytes still remains as the cost effective tool for screening renal disease in RA. However renal biopsy remains the ‘gold standard’ investigation for the diagnosis of renal pathology with certainty. Great emphasis has to be placed on regular and periodic screening, because the detection of renal disease early has got two implications. First, most of the drug induced renal lesions resolve spontaneously after prompt cessation of the offending drug; say for an example gold induced membranous nephropathy. Second, some of the disease modifying anti-rheumatic drugs require dose reduction in the presence of renal failure like methotrexate. There are various clinical case series and autopsy studies available in the literature highlighting the renal involvement in RA. Most of the studies come either from Japan or from other overseas countries. Except for few case reports, there are not much of Indian studies regarding the renal involvement in RA. This study is intended to evaluate renal lesion in RA among Indian patients in a tertiary care hospital in south India. AIM OF THE STUDY : To evaluate renal lesions in patients with Rheumatoid arthritis and to assess the clinicopathologic correlations. To assess the course and prognosis of renal diseases in patients with Rheumatoid arthritis. METHODS : All rheumatoid arthritis patients were subjected to screening tests which included urine analysis and blood urea and serum creatinine estimation. Urine analysis, blood urea and serum creatinine estimation were done at renal lab, department of nephrology. CONCLUSION : 1. Renal involvement in rheumatoid arthritis can remain asymptomatic. Hence a well planned screening is essential to identify renal involvement early. 2. There can be a wide variety of renal diseases caused either by the disease itself or by the drugs used to treat the condition, and very often it may be difficult to differentiate between the two. 3. Renal biopsy remains the ‘gold standard’ procedure in diagnosing the renal pathology with certainty. 4. Mesangio-proliferative glomerulopathy followed by focal endocapillary proliferative glomerulonephritis were the commonest glomerular lesions noted in the present study. 5. Membranous nephropathy is declining, owing to the phasing out of gold and pencillamine therapy. It can still occur in the absence of exposure to these drugs. 6. Chronic kidney disease also occurs with increased frequency in rheumatoid arthritis, with majority of patients maintaining a stable GFR.

Item Type: Thesis (Masters)
Uncontrolled Keywords: renal lesions ; rheumatoid arthritis ; clinico-pathologic correlation.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 04:45
Last Modified: 11 Jul 2017 04:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/1375

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