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Infliximab-associated focal segmental glomerulosclerosis in a patient with ankylosing spondylitis

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Abstract

The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of spondyloarthritis (SpA). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects ranging from common ones including infections to uncommon renal complications. This report describes a case of infliximab-induced focal segmental glomerulosclerosis (FSGS) in a 40-year-old female patient with ankylosing spondylitis (AS) who presented with asymptomatic proteinuria and microscopic hematuria. To the best of our knowledge, this is the second reported case of FSGS attributed to infliximab (IFX). A review of the English literature was conducted for cases of possible IFX-associated renal disorders in patients with SpA and SpA spectrum diseases. In this respect, the reported renal pathologies were IgA nephropathy, crescentic glomerulonephritis, acute renal artery occlusion, acute tubulointerstitial nephritis (ATIN), FSGS, and membranous glomerulopathy. Furthermore, partial or complete resolution was reported after cessation of therapy. In conclusion, although renal complications of TNF inhibitors (TNFi) are uncommon, spot urine evaluation may be recommended in the follow-up of patients treated with TNFi.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Handan Yarkan Tuğsal, Berrin Zengin, Gökçe Kenar, Gerçek Can, Fatoş Önen & Merih Birlik

  2. Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Mehtat Ünlü

Authors
  1. Handan Yarkan Tuğsal
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  2. Berrin Zengin
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  3. Gökçe Kenar
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  4. Gerçek Can
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  5. Mehtat Ünlü
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  6. Fatoş Önen
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  7. Merih Birlik
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Contributions

All the authorship contributions were declared in line with the ICMJE 4 criteria: Dr. Yarkan Tuğsal and Dr. Birlik wrote the paper. Dr. Zengin and Dr. Kenar searched the databases for review of the literature. Dr. Can and Dr. Önen read the selected articles and evaluated for eligibility. Dr. Ünlü evaluated pathology of the kidney. Dr. Yarkan Tuğsal, Dr. Kenar and Dr. Birlik revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Handan Yarkan Tuğsal.

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Yarkan Tuğsal, H., Zengin, B., Kenar, G. et al. Infliximab-associated focal segmental glomerulosclerosis in a patient with ankylosing spondylitis. Rheumatol Int 39, 561–567 (2019). https://doi.org/10.1007/s00296-019-04241-8

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  • DOI: https://doi.org/10.1007/s00296-019-04241-8

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