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Clinical Rheumatology

, Volume 17, Issue 6, pp 524–530 | Cite as

Renal diseases in ankylosing spondylitis: Review of the literature illustrated by case reports

  • E. S. Strobel
  • E. Fritschka
Case Report

Abstract

Ankylosing spondylitis (AS) can be accompanied by extraarticular manifestations in the cardiovascular, pulmonary, neurologic and renal organs. Secondary renal amyloidosis is the most common cause of renal involvement in AS (62%) followed by IgA nephropathy (30%), mesangioproliferative glomerulonephritis (5%) as well as rarely membranous nephropathy (1%), focal segmental glomerulosclerosis (1%) and focal proliferative glomeruleonephritis (1%). Treatment associated nephrotoxicity may result from non-steroidal anti-inflammatory drugs or disease modifying agents.

The purpose of this paper was to alert for the possiblity of renal damage in AS and to analyse the frequencies of different etiologies of renal involvement. Two typical case reports of renal involvement in AS are presented to illustrate the clinical course of such patients. Renal side effects and possible pre-existing renal diseases should be taken into account while choosing the appropriate medication for patients with AS.

Keywords

Amyloidosis Ankylosing Spondylitis Glomerulonephritis Renal insufficiency 

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References

  1. 1.
    Stamato T, Laxer RM, de Freitas C, Gow R, Silverman ED, Luy L, et al. Prevalence of cardiac manifestations of juvenile ankylosing spondylitis. Am J Cardiol 1995;75:744–6.PubMedGoogle Scholar
  2. 2.
    Strobel ES, Fritschka E. Fatal pulmonary complication in ankylosing spondylitis. Case report and review of the literature. Clin Rheumatol 1997;16:617–22.PubMedGoogle Scholar
  3. 3.
    Sant SM, O'Connell D. Cauda equina syndrome in ankylosing spondylitis: a case report and review of the literature. Clin Rheumatol 1995;14:224–6.PubMedGoogle Scholar
  4. 4.
    Sissons JGP, Woodrow DF, Curtis JR, Evans DJ, Gower PE, Sloper JC, et al. Isolated glomerulonephritis with mesangial IgA deposits. Br Med J 1975;3:611–4.PubMedGoogle Scholar
  5. 5.
    Vilar MJP, Cury SE, Ferraz MB, Sesso R, Atra E. Renal abnormalities in ankylosing spondylitis. Scand J Rheumatol 1997;26:19–23.PubMedGoogle Scholar
  6. 6.
    Kirschenbaum MA, Anderson DA. Nephropathies of nonsteroidal antiinflammatory agents. In: Massry SG, Glassock RJ, editors. Textbook of nephrology, 2nd edn. Baltimore: Williams and Wilkins, 1989:823–8.Google Scholar
  7. 7.
    Cruickshank B. Pathology of ankylosing spondylitis. Clin Orthop 1971;74:43–58.PubMedGoogle Scholar
  8. 8.
    Lehtinen K. Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis 1993;52:174–6.PubMedGoogle Scholar
  9. 9.
    Escalante A, Weaver WJ, Beardmore TD. An estimate of the prevalence of reactive systemic amyloidosis in ankylosing spondylitis [letter]. J Rheumatol 1995;22:2192–3.PubMedGoogle Scholar
  10. 10.
    Lance NJ, Curran JJ. Amyloidosis in a case of ankylosing spondylitis with a review of the literature. J Rheumatol 1991;18:100–3.PubMedGoogle Scholar
  11. 11.
    Escalante A, Ehresmann GR, Quismorio FP Jr. Regression of reactive systemic amyloidosis due to ankylosing spondylitis following the administration of colchicine. Arthritis Rheum 1991;34:920–2.PubMedGoogle Scholar
  12. 12.
    Gallar P, Oliet A, Hernandez E, Vigil A, Crespo M. Amyloidosis and ankylosing spondylitis [letter] Clin Nephrol 1992;37:269.Google Scholar
  13. 13.
    Pascual J, Teruel JL, Ortuno J. Endstage renal disease in a case of AS and amyloidosis [letter]. J Rheumatol 1992;19:183–4.Google Scholar
  14. 14.
    Gratacos J, Collado A, Sanmarti R, Poch E, Torras A, Munoz-Gomez J. Coincidental amyloid nephropathy and IgA glomerulonephritis in a patient with ankylosing spondylitis. J Rheumatol 1993;20:1613–5.PubMedGoogle Scholar
  15. 15.
    Gratacos J, Orellana C, Sanmarti R, Sole M, Collado A, Gomez-Casanovas E, et al. Secondary amyloidosis in ankylosing spondylitis. A systematic survey of 137 patients using abdominal fat aspiration. J Rheumatol 1997;24:912–5.PubMedGoogle Scholar
  16. 16.
    Sungur C, Sungur A, Akpolat T, Arik N. Diagnostic value of bone marrow biopsy in patients with AA-type renal amyloidosis secondary to ankylosing spondylitis [letter]. Nephrol Dial Transplant 1998;11:2520–1.Google Scholar
  17. 17.
    Calin A. Ankylosing spondylitis. In: Kelley WN, Harris Jr ED, Ruddy S, Sledge CB, editors. Textbook of rheumatology, 3rd edn. Philadelphia: WB Saunders, 1989;1021–37.Google Scholar
  18. 18.
    Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. N Engl J Med 1997;337:898–909.PubMedGoogle Scholar
  19. 19.
    Schneider F. Die AA-Amyloidose bei entzündlich-rheumatischen Erkrankungen. Z Rheumatol 1992;51:177–82.PubMedGoogle Scholar
  20. 20.
    Breedveld FC, Markusse HM, MacFarlane JD. Subcutaneous fat biopsy in the diagnosis of amyloidosis secondary to chronic arthritis. Clin Exp Rheumatol 1989;7:407–10.PubMedGoogle Scholar
  21. 21.
    Klemi PJ, Sorsa S, Happonen RP. Fine-needle aspiration biopsy from subcutaneous fat. Scand J Rheumatol 1987;16:429–31.PubMedGoogle Scholar
  22. 22.
    Duston MA, Skinner M, Meenan MF, Cohen A. Sensitivity, specificity and predictive value of abdominal fat aspiration for the diagnosis of amyloidosis. Arthritis Rheum 1989;32:82–5.PubMedGoogle Scholar
  23. 23.
    Gertz MA, Kyle RE. Secondary systemic amyloidosis: response and survival in 64 patients. Medicine (Baltimore) 1991;70:246–56.Google Scholar
  24. 24.
    Bailey RR, Burry AF, McGiven AR, Kirk JA, Laing JK, Moller P. A renal lesion in ankylosing spondylitis. Nephron 1980;26:171–3.PubMedGoogle Scholar
  25. 25.
    Jennette JC, Ferguson AL, Moore MA, Freeman DG. IgA nephropathy associated with seronegative spondylarthropathies. Arthritis Rheum 1982;25:144–9.PubMedGoogle Scholar
  26. 26.
    Dard S, Kenouch S, Mery JP, et al. A new association: ankylosing spondylitis and Berger's disease. Nephrologie 1982;3:183a.Google Scholar
  27. 27.
    van Liebergen FJHM, Assmann KJM, Koene RAP, van de Putte LBA. IgA nephropathy and ankylosing spondylitis. Kidney Int 1983;24:408a.Google Scholar
  28. 28.
    Wall BA, Agudelo CA, Pisko EJ. Increased incidence of recurrent hematuria in ankylosing spondylitis: a possible association with IgA nephropathy. Rheumatol Int 1984;4:27–9.PubMedGoogle Scholar
  29. 29.
    Krothapalli R, Neeland B, Small S, Duffy WB, Gyorkey F, Senekjian HO. IgA nephropathy in a patient with ankylosing spondylitis and a solitary kidney. Clin Nephrol 1984;21:134–7.PubMedGoogle Scholar
  30. 30.
    Bruneau C, Villiaumey J, Avouac B, Martigny J, Laurent J, Pichot A, et al. Seronegative spondyloarthropathies and IgA glomerulonephritis: a report of four cases and a review of the literature. Semin Arthritis Rheum 1986;15:179–84.PubMedGoogle Scholar
  31. 31.
    Shu KH, Lian JD, Yang YF, Lu YS, Wang JY, Lan JL, et al. Glomerulonephritis in ankylosing spondylitis. Clin Nephrol 1986;25:169–74.PubMedGoogle Scholar
  32. 32.
    Jones DW, Mansell MA, Samuell CT, Isenberg DA. Renal abnormalities in ankylosing spondylitis. Br J Rheumatol 1987;26:341–5.PubMedGoogle Scholar
  33. 33.
    Kanterewicz E, Sanmarti R, Collado A, Brancos MA, Torras A, Rotes Querol J. IgA nephropathy in a young female with ankylosing spondylitis. Br J Rheumatol 1987;26:396–7.PubMedGoogle Scholar
  34. 34.
    Andersen GN. IgA-nephropathia in a patient with ankylosing spondylitis. Scand J Rheumatol 1992;21:46–7.PubMedGoogle Scholar
  35. 35.
    Nabokov AV, Shabunin MA, Smirnov AV. Renal involvement in ankylosing spondylitis (Bechterew's disease). Nephrol Dial Transplant 1996;11:1172–5.PubMedGoogle Scholar
  36. 36.
    Malaviya AN, Raina V, Mittal V, Narayanan K, Malhotra KK, Bhuyan UN, et al. Glomerulonephritis in seronegative spondylarthritis syndrome [letter]. Arthritis Rheum 1981;24:751–2.PubMedGoogle Scholar
  37. 37.
    Botey A, Torras A, Revert L. Membranous nephropathy in ankylosing spondylitis. Nephron 1981;29:203.PubMedGoogle Scholar
  38. 38.
    Fritschka E. Therapie der Glomerulonephritiden. Der Mediziner 1996;11:26–31.Google Scholar
  39. 39.
    Scheinman JI, Trachman H, Lin CY, Langman CB, Chan JCM. IgA nephropathy: to treat or not to treat? Nephron 1997;75:251–8.PubMedGoogle Scholar
  40. 40.
    Ponticelli C, Zucchelli P, Passerini P, Cagnoli L, Cesana B, Pozzi C, et al. A randomized trial of methylprednisolone and chlorambucil in idiopathic membranous nephropathy. N Engl J Med 1989;320:8–13.PubMedGoogle Scholar
  41. 41.
    Creemers MCW, Van Riel PLCM, Franssen MJAM, van de Putte LBA, Gribnau FWJ. Second-line treatment in seronegative spondylarthropathies. Semin Arthritis Rheum 1994;24:71–81.PubMedGoogle Scholar
  42. 42.
    Grasedyck K, Schattenkirchner M, Bandilla K. Zur Behandlung der Spondylitis ankylosans mit Auranofin (Ridaura). Z Rheumatol 1990;49:98–9.PubMedGoogle Scholar
  43. 43.
    Gordon DA. Gold compounds. In: Kelley WN, Harris Jr ED, Ruddy S, Sledge CB, editors. Textbook of rheumatology, 3rd edn. Philadelphia: WB Saunders, 1989:804–23.Google Scholar

Copyright information

© Clinical Rheumatology 1998

Authors and Affiliations

  • E. S. Strobel
    • 1
  • E. Fritschka
    • 2
  1. 1.Department of MedicineFreiburg University HospitalFreiburgGermany
  2. 2.Schwerpunktklinik für NephrologieLVA Sinntalklinik Bad BrückenauBad BrückenauGermany

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