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Abstract
Background The problem of chronic kidney diseases (CKD) in rheumatoid arthritis (RA) patients have not been fully studied. The role of biological therapy (BT) is poorly understood.
Objectives Aim of the study was to examine the prevalence, risk factors and histological variants of CKD in RA, and impact of pharmacotherapy.
Methods 135 patients with RA from 2013 to 2018 were enrolled in this study. Age, gender, duration of RA, drug therapy, ESR, CRP, DAS28, renal function, proteinuria (PU), histological variants were analyzed. Arterial hypertension, weight index, serum lipids and glucose levels were also assessed.
Results The incidence of CKD in RA was 30.4% (41 from 135). CKD 3-4 stages with eGFR < 60ml/min/1.73m2 was detected in 14.8% patients. The duration of the disease, high ESR and DAS28 score, NSAIDs treatment and hyperlipidemia were risk factors for CKD in RA (Fig 1). We also found negative correlation between the DAS28 and eGFR (Fig. 2).
Amyloidosis was the most common histologic pattern (51.52%), followed by chronic glomerulonephritis (CGN) (24.24%) and tubulo-interstitial nephritis (24.24%). Among CGN mesangial glomerulonephritis was the most frequent (Table 1). Renal amyloidosis was associated with a duration of RA, presence of systemic symptoms and CRP level.
The levels of PU were lower, and eGFR levels were higher in patients treated with BT than in patients treated with synthetic disease-modifying anti-rheumatic drugs (DMARDs) (Fig 3).
Conclusion CKD is often developed in patients with high RA activity. Treatment with biological agents is associated with a lower PU and higher GFR levels.
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Renal histopathologic findings in RA patients (n=33)
Disclosure of Interests None declared