Abstract
The objective of this study was to assess the long-term prognosis of nephropathy findings and the incidence of new abnormal clinical renal findings in patients with rheumatoid arthritis (RA). The original population-based cross-sectional study of 604 RA patients was carried out in 1988, 103 nephropathy patients being found. Controls matched for age, sex, and duration of RA were selected from among RA patients with normal renal function and urinalysis in 1988. In 2003, a follow-up study was made of the 103 nephropathy patients and 102 controls, and the median follow-up time was 13 years. In the original nephropathy group, serum creatinine exceeded 200 μmol/l in 8% of the original isolated hematuria patients, in 30% of the isolated proteinuria patients, in 57% of the combined hematuria and proteinuria patients, but in none of the isolated chronic renal failure (CRF) patients (p = 0.001 for the difference). Probable or definitive renal amyloidosis was diagnosed in 19% of the nephropathy patients. Dialysis therapy was given to 10 out of the 103 nephropathy patients, nine of them belonging to the original isolated proteinuria or combined hematuria and proteinuria groups. There were six renal deaths among the nephropathy patients, and none in the controls. In the control group, new abnormal renal findings, in most cases mild, were detected in 28%. Serum creatinine exceeded 200 μmol/l in 4% of the controls, and dialysis therapy was given to 2% of the controls. Probable or definitive renal amyloidosis was diagnosed in 4% of this group. With regards to the development or progression of chronic renal failure, the long-term clinical prognosis of isolated hematuria and isolated CRF was found to be favorable. Proteinuria alone or combined with hematuria or CRF was related to evidently poorer prognosis.
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References
Ørjavik O, Brodvall EK, Øystese B et al (1981) A renal biopsy study with light and immunofluorescence microscopy in rheumatoid arthritis. Acta Med Scand Suppl 645:9–14
Sellars L, Siamopoulos K, Wilkinson R et al (1983) Renal biopsy appearances in rheumatoid disease. Clin Nephrol 20:114–120
Hordon LD, Sellars L, Morley AR et al (1984) Hematuria in rheumatoid arthritis: an association with mesangial glomerulonephritis. Ann Rheum Dis 43:440–443
Helin H, Korpela M, Mustonen J et al (1986) Mild mesangial glomerulopathy—a frequent finding in rheumatoid arthritis patients with hematuria or proteinuria. Nephron 42:224–230
Hazenberg PBC, van Rijswijk MH (1994) Clinical and therapeutic aspects of AA amyloidosis. Baillieres Clin Rheumatol 8:661–690
Richards IM, Fraser SM, Capell HA et al (1988) A survey of renal function in outpatients with rheumatoid arthritis. Clin Rheumatol 7:267–271
Leonard PA, Bienz SR, Clegg DO et al (1987) Hematuria in patients with rheumatoid arthritis receiving gold and D-penicillamine. J Rheumatol 14:55–59
Korpela M, Mustonen J, Heikkinen A et al (1995) Isolated microscopic hematuria in patients with rheumatoid arthritis compared with age and sex matched controls. A population based study. J Rheumatol 22:427–431
Koseki Y, Terai C, Moriguchi M et al (2001) A prospective study of renal disease in patients with early rheumatoid arthritis. Ann Rheum Dis 60:327–331
Korpela M. (1993) Rheumatoid arthritis and the kidneys—a cross-sectional study on prevalence, clinical significance and risk of renal and urinary tract diseases in patients with rheumatoid arthritis. Publications of the Social Insurance Institution ML:122, Helsinki
Nived O, Sturfelt G, Westling H et al (1983) Is serum creatinine concentration a reliable index of renal function in rheumatic diseases? Br Med J 286:684–685
Boers M, Dijkmans BAC, Breedenveld FC et al (1988) Errors in the prediction of creatinine clearance in patients with rheumatoid arthritis. Br J Rheumatol 27:233–235
Anders H-J, Rihl M, Loch O et al (2000) Prediction of creatinine clearance from serum creatinine in patients with rheumatoid arthritis: comparison of six formulae and one nomogram. Clin Rheumatol 19:26–29
Boers M, Dijkmans BAC, Breedenveld FC et al (1990) Subclinical renal dysfunction in rheumatoid arthritis. Arthritis Rheum 33:95–101
Sihvonen S, Korpela M, Mustonen J et al (2004) Renal disease as a predictor of increased mortality among patients with rheumatoid arthritis. Nephron Clin Pract 96:c107–c114
Westermark P, Stenkvist B (1973) A new method for the diagnosis of systemic amyloidosis. Arch Intern Med 132:552–553
Helin HJ, Korpela MM, Mustonen JT et al (1995) Renal biopsy findings and clinicopathologic correlations in rheumatoid arthritis. Arthritis Rheum 38:242–247
Obana M, Adachi M, Matsuoka Y et al (1990) Clinical studies on amyloidosis complicated with rheumatoid arthritis, with particular reference to nephropathy. Jpn J Med 29(3):274–282
Perrone RD, Madias NE, Levey AS (1992) Serum creatinine as an index of renal function: New insights into old concepts. Clin Chem 38:1933–1953
Salli L, Scalici G, Corrao S et al (1990) Microproteinuria as an index of initial renal lesion in patients with rheumatoid arthritis. Clin Exp Rheumatol 8:397–400
Niederstadt C, Happ T, Tatsis E et al (1999) Glomerular and tubular proteinuria as markers of nephropathy in rheumatoid arthritis. Rheumatology 38:28–33
Acknowledgments
This work was supported by grants from the Competitive research funding of the Pirkanmaa Hospital District and Tampereen Reumayhdistys, the Local Branch of the Finnish Rheumatism Association. We thank Heini Huhtala for statistical advice, Tiina Luukkaala for statistical assistance, and Heidi Marika Mäkinen for technical assistance.
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Karstila, K., Korpela, M., Sihvonen, S. et al. Prognosis of clinical renal disease and incidence of new renal findings in patients with rheumatoid arthritis: follow-up of a population-based study. Clin Rheumatol 26, 2089–2095 (2007). https://doi.org/10.1007/s10067-007-0625-y
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DOI: https://doi.org/10.1007/s10067-007-0625-y