Clinicopatological variants and risk factors for chronic kidney disease in rheumatoid arthritis

Cover Page

Abstract


Recent studies have shown a high risk of chronic kidney disease and associated cardiovascular complications in patients with rheumatoid arthritis (RA), which determines the prognosis. However, the prevalence of chronic kidney disease (CKD) in RA has not been established in the Russians.

Aim. Study was to examine the prevalence, risk factors and histological variants of CKD in RA.

Materials and methods. 180 patients with rheumatoid arthritis were observed in the Tareev clinic of nephrology, for the period from 2014 to 2019 years. Age, gender, duration of RA, drug therapy, ESR, CRP, DAS28, renal function, proteinuria, histological variants were analyzed. Of the common population risk factors for CKD arterial hypertension, weight index, serum lipids and glucose levels were also assessed.

Results. The prevalence of CKD in RA was 19.7%. Age, presence and stage of arterial hypertension, an increase in body mass index, as well as high rates of disease activity – ESR, CRP, DAS28 score and duration of RA were risk factors of CKD in RA. Age, duration of the disease, stage of AH and hypercholesterolemia were risk factors in multifactorial regression analysis. Amyloidosis was the most common histologic pattern (50.0%), followed by chronic glomerulonephritis (30.4%) and tubulo-interstitial nephritis (19.6%). Among chronic glomerulonephritis mesangial glomerulonephritis was the most frequent. Renal amyloidosis was associated with a duration of RA, presence of systemic symptoms and CRP level. An isolated decrease in GFR of less than 60 ml/min was detected in 31 (36.0%) out of 86 patients.

Сonclusion. The risk factors for CKD in patients with RA are activity and duration of the disease In addition to common population factors. Amyloidosis was the most common histologic pattern associated with duration of RA and inflammatory proteins levels.


Full Text

Restricted Access

About the authors

N. V. Chebotareva

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0003-2128-8560

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

S. V. Gulyaev

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0001-6138-4333

Russian Federation, Moscow

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии

T. V. Androsova

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0002-9951-126X

Russian Federation, Moscow

к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии

E. N. Popova

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0001-5164-4621

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

D. V. Gurova

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0001-8232-3679

Russian Federation, Moscow

студентка

P. I. Novikov

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0003-0148-5655

Russian Federation, Moscow

к.м.н., зав. отд-нием ревматологии

L. Yu. Milovanova

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru
ORCID iD: 0000-0002-5599-0350

Russian Federation, Moscow

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

S. V. Moiseev

Sechenov First Moscow State Medical University (Sechenov University)

Email: natasha_tcheb@mail.ru

Russian Federation, Moscow

д.м.н., проф., зав. каф. внутренних, профессиональных болезней и ревматологии

References

  1. Hickson LJ, Crowson CS, Gabriel SE, et al. Development of reduced kidney function in rheumatoid arthritis. Am J Kidney Dis. 2014;63:206-13. doi: 10.1053/j.ajkd.2013.08.010
  2. Listing J, Kekow J, Manger B, et al. Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab. Ann Rheum Dis. 2015;74(2):415-21. doi: 10.1136/annrheumdis-2013-204021
  3. Насонов Е.Л., Каратеев Д.Е., Балабанова Р.М. Ревматоидный артрит. В кн.: Ревматология. Национальное руководство. Под. ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008; с. 290-331 [Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Rheumatology. National Guide. Nasonov EL, Nasonova VA, ed. Moscow: GEOTAR-Media, 2008; p. 290-331 (In Russ.)].
  4. Tokoroyama T, Ando M, Setoguchi K, et al. Prevalence, incidence and prognosis of chronic kidney disease classified according to current guidelines: a large retrospective cohort study of rheumatoid arthritis patients. Nephrol Dial Transplant. 2017;32:2035-42. doi: 10.1093/ndt/gfw315
  5. Kim HW, Lee CK, Cha HS, et al. Effect of anti-tumor necrosis factor alpha treatment of rheumatoid arthritis and chronic kidney disease. Rheumatol Int. 2015;35(4):727-34. doi: 10.1007/s00296-014-3146-4
  6. Оранский С.П. Хроническая болезнь почек при ревматоидном артрите: ассоциация с сердечно-сосудистым риском. Фундаментальные исследования. 2013;12:285-8 [Oranskij SP. Hronicheskaya bolezn pochek pri revmatoidnom artrite: associaciya s serdechno-sosudistym riskom. Fundamentalnye issledovaniya. 2013;12:285-8 (In Russ.)]. http://www.fundamental-research.ru/ru/article/view?id=33321
  7. Батюшин М.М., Выставкина Е.А. Факторы риска развития и прогрессирования хронической болезни почек у больных ревматоидным артритом. Современные проблемы науки и образования. 2011;5 [Batyushin MM, Vystavkina EA. Faktory riska razvitiya i progressirovaniya hronicheskoj bolezni pochek u bolnyh revmatoidnym artritom. Sovremennye problemy nauki i obrazovaniya. 2011;5 (In Russ.)]. http://www.science-education.ru/ru/article/view?id=4871
  8. Саркисова И.А., Рамеев В.В., Козловская Л.В. Ревматоидный артрит как основная причина развития АА-амилоидоза. Клиническая геронтология. 2009;15(2):14-20 [Sarkisova IA, Rameev VV, Kozlovskaya LV. Revmatoidnyj artrit kak osnovnaya prichina razvitiya AA-amiloidoza. Klinicheskaya gerontologiya. 2009;15(2):14-20 (In Russ.)].
  9. Саркисова И.А., Рамеев В.В., Козловская Л.В. Факторы риска развития и прогрессирования АА-амилоидоза у больных ревматоидным артритом. Нефрология и диализ. 2007;9(3):346 [Sarkisova IA, Rameev VV, Kozlovskaya LV. Faktory` riska razvitiya i progressirovaniya AA-amiloidoza u bolnykh revmatoidnym artritom. Nefrologiya i dializ. 2007;9(3):346 (In Russ.)].
  10. Саркисова И.А., Рамеев В.В., Варшавский В.А. и др. Особенности течения АА-амилоидоза у больных ревматоидным артритом. Терапевтический архив. 2006; 78(5):31-6 [Sarkisova IA, Rameev VV, Varshavskij VA, et al. Osobennosti techeniya AA-amiloidoza u bol`ny`kh revmatoidny`m artritom. Therapeutic Archive. 2006;78(5):31-6 (In Russ.)].
  11. Góis M, Carvalho F, Sousa H, et al. Renal involvement in rheumatoid arthritis: analysis of 53 renal biopsies. Port J Nephrol Hypert. 2017;31(1):25-30.
  12. Ребров А.П., Тяпкина М.А., Волошинова Е.В. Субклиническое поражение почек у пациентов с ревматоидным артритом. Лечащий врач. 2012;4:40-2 [Rebrov AP, Tyapkina MA, Voloshinova EV. Subclinical failure of kidneys in patients with rheumatoid arthritis. Lechashchij vrach. 2012;4:40-2 (In Russ.)].
  13. Киселева А.Г., Орлова Г.М., Бердникова И.А., Фереферова Н.М. Хроническая болезнь почек у больных ревматоидным артритом. Сибирский медицинский журнал. 2007;7:90-2 [Kiseleva AG, Orlova GM, Berdnikova IA, Fereferova NM. Chronic kidney disease in rheumatoid arthritis patients. Sibirskij medicinskij zhurnal, 2007;7:90-2 (In Russ.)].
  14. Kochi M, Kohagura K, Shiohira Y, et al. Inflammation as a risk of developing chronic kidney disease in rheumatoid arthritis. PLoS One. 2016;11(8):e0160225. doi: 10.1371/journal.pone.0160225
  15. Shankar A, Sun L, Klein BE, et al. Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 2011;80(11):1231-8. doi: 10.1038/ki.2011.283
  16. Nakahara C, Kanemoto K, Saito N, et al. C-reactive protein frequently localizes in the kidney in glomerular diseases. Clin Nephrol. 2001;55(5):365-70.
  17. Schwedler SB, Guderian F, Dämmrich J, et al. Tubular staining of modified C-reactive protein in diabetic chronic kidney disease. Nephrol Dial Transplant. 2003;18(11):2300-7. doi: 10.1093/ndt/gfg407
  18. Li ZI, Chung AC, Zhou L, et al. C-reactive protein promotes acute renal inflammation and fibrosis in unilateral ureteral obstructive nephropathy in mice. Lab Invest. 2011;91(6):837-51. doi: 10.1038/labinvest.2011.42
  19. Galarraga B, Khan F, Kumar P, et al. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology (Oxford). 2008;47(12):1780-4. doi: 10.1093/rheumatology/ken386
  20. Tapia E, Sánchez-González DJ, Medina-Campos ON, et al. Treatment with pyrrolidine dithiocarbamate improves proteinuria, oxidative stress, and glomerular hypertension in overload proteinuria. Am J Physiol Renal Physiol. 2008;295(5):F1431-9. doi: 10.1152/ajprenal.90201.2008
  21. Boers M, Croonen AM, Dijkmans BA, et al. Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies. Ann Rheum Dis. 1987;46:658-63. doi: 10.1136/ard.46.9.658
  22. Toblli JE, Bevione P, Di Gennaro F, et al. Understanding the mechanisms of proteinuria: therapeutic implications. Int J Nephrol. 2012;546039. doi: 10.1155/2012/546039
  23. Hemmelgarn BR, Manns BJ, Lloyd A, et al; Alberta Kidney Disease Network. Relation between kidney function, proteinuria, and adverse outcomes. J Am Med Assoc. 2010;303(5):423-9. doi: 10.1001/jama.2010.39
  24. Möller B, Pruijm M, Adler S, et al. Chronic NSAID use and long-term decline of renal function in a prospective rheumatoid arthritis cohort study. Ann Rheum Dis. 2015;74(4):718-23. doi: 10.1136/annrheumdis-2013-204078
  25. Daoussis D, Panoulas VF, Antonopoulos I, et al. Cardiovascular risk factors and not disease activity, severity or therapy associate with renal dysfunction in patients with rheumatoid arthritis. Ann Rheum Dis. 2010;69:517-21. doi: 10.1136/ard.2008.105049
  26. Salomon MI, Gallo G, Poon TP, et al. The kidney in rheumatoid arthritis. Nephron. 1974;12:297310.
  27. Ramirez G, Lambert R, Bloomer A. Renal pathology in patients with rheumatoid arthritis. Nephron. 1981;29:124-6. doi: 10.1159/000182132
  28. Yoshida A, Morozumi K, Suganuma T, et al. Clinicopathological study of nephropathy in patients with rheumatoid arthritis. Ryumachi. 1991;31:14-21.
  29. Helin HJ, Korpela MM, Mustonen JT, Pasternack AI. Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arth Rheum. 1995;38(2):242-7. doi: 10.1002/art.1780380213
  30. Nakano M, Ueno M, Nishi S, et al. Analysis of renal pathology and drug history in 158 Japanese patients with rheumatoid arthritis. Clin Nephrol. 1998;50:154-60.
  31. Makino H, Yoshinaga Y, Yamasaki Y, et al. Renal involvement in rheumatoid arthritis: analysis of renal biopsy specimens from 100 patients. Mod Rheumatol. 2002;12:148-54. doi: 10.3109/s101650200025
  32. Scott DG, Bacon PA. Intravenous cyclophosphamide plus methylprednisolone in treatment of systemic rheumatoid vasculitis. Am J Med. 1984;76:377-84. doi: 10.1016/0002-9343(84)90654-5
  33. Sumida K, Molnar MZ, Potukuchi PK, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018;93(5):1207-16. doi: 10.1016/j.kint.2017.11.025
  34. Gonzalez-Juanatey C, Llorca J, Vazquez-Rodriguez TR, et al. Short-term improvement of endothelial function in rituximab-treated rheumatoid arthritis patients refractory to tumor necrosis factor alpha blocker therapy. Arthritis Rheum. 2008;59(12):1821-4. doi: 10.1002/art.24308
  35. Popa C, Netea MG, Radstake T, et al. Influence of anti-tumour necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis. Ann Rheum Dis. 2005;64(2):303-5. doi: 10.1136/ard.2004.023119
  36. Gonzalez-Gay MA, De Matias JM, Gonzalez-Juanatey C, et al. Anti-tumor necrosis factor-alpha blockade improves insulin resistance in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2006;24(1):83-6.
  37. Immonen K, Finne P, Gronhagen-Riska C, et al. A marked decline in the incidence of renal replacement therapy for amyloidosis associated with inflammatory rheumatic diseases. Scand J Rheumatol. 2009;38:403. doi: 10.3109/13506129.2010.549252
  38. Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, et al. Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists. Am J Med. 2005;118(5):552-6. doi: 10.1016/j.amjmed.2005.01.028
  39. Nakamura T, Higashi S, Tomoda K, et al. Effectiveness of etanercept vs cyclophosphamide as treatment for patients with amyloid A amyloidosis secondary to rheumatoid arthritis. Rheumatology (Oxford). 2012;51(11):2064-9. doi: 10.1093/rheumatology/kes190
  40. Gottenberg JE, Merle-Vincent F, Bentaberry F, et al. Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy. Arthritis Rheum. 2003;48(7):2019-24. doi: 10.1002/art.11163

Supplementary files

There are no supplementary files to display.

Statistics

Views

Abstract - 49

PDF (Russian) - 22

Cited-By


PlumX

Dimensions

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies