Changes in RA treatment strategies may alter renal biopsy choices

Changes in treatment strategies available for patients with rheumatoid arthritis may have changed the course of renal biopsies ordered by physicians, according to a recently published study.

A retrospective, observational study of 65 patients (48 women) with rheumatoid arthritis (RA) who had a renal biopsy between 1976 and 2015 at a single university hospital in Argentina was conducted. Patients were stratified into three periods based on treatments commonly used at the time. The first group of patients attended between 1976 and 1989, when gold salts and D-penicillamine (DPA) were commonly used as treatments and included 27 patients with renal biopsies. The second period was between 1990 and 2002 when methotrexate was more commonly prescribed and included 22 patients. The third period was between 2003 and 2015 after biologics became available in Argentina and included 16 patients.

The most common finding in renal biopsies was renal amyloidosis in 20 patients (31%), 16 of whom were women with a mean age of 48.4 years (range 19 to 70 years) and time between renal disease and RA onset was 15 years. The second most common finding was mesangial glomerulonephritis in 12 patients (18%), half of whom were men, with mean RA disease duration before detection of renal diagnosis of 5.7 years. The third most common finding was membranous nephropathy in 11 patients, 10 of whom were women, with a mean disease duration of 7.5 years prior to renal findings.

Ten patients, all women with a mean age of 38.7 years (range 18 to 54 years) and RA disease duration of 9.4 years, had extracapillary proliferative glomerulonephritis on renal biopsy. Minimal change nephropathy was present in three patients (two women) with a mean age of 50 years (range 16 to 8 years) and mean disease duration of 7.3 years.

Renal amyloidosis was the leading cause of kidney disease between 1976 and 2002, but decreased by 40% between 1990 and 2002 and by 60% in the third period (2003-2015). Mesangial glomerulonephritis was most common between 2003 and 2015. Membranous nephropathy was related to treatment with gold salts in five of 11 patients (45%), decreased in frequency in the between 1990 and 2002 in three patients and was limited to one patient between 2003 and 2015. – by Shirley Pulawski

Disclosure: The researchers report no relevant financial disclosures.

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Source:

Vinicki JP, et al. J Clin Rhem. 2015;doi:10.1097/RHU.0000000000000302.