Kosin Med J.  2018 Jun;33(1):85-90. 10.7180/kmj.2018.33.1.85.

IgA nephropathy in a patient with ankylosing spondylitis well controlled with etanercept

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. gtah@hanmail.net
  • 2Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.

Abstract

Ankylosing spondylitis (AS) can involve the eye, gastrointestinal system, cardiopulmonary system, skin, kidneys, and spinal and peripheral joints. It is rarely accompanied by immunoglobulin A (IgA) nephropathy. Although IgA is involved in both AS and IgA nephropathy, the relationship between these diseases remains unclear. We detected hematuria and proteinuria in a 32-year-old male patient with ankylosing spondylitis that remained stable for 4 years through treatment with etanercept, a tumor necrosis factor-α (TNF-α) inhibitor, and diagnosed IgA nephropathy through a renal biopsy. IgA nephropathy seems to be less commonly associated with AS disease activity or specific treatment such as TNF-α inhibitor use.

Keyword

Ankylosing spondylitis; IgA glomerulonephritis; Tumor necrosis factor alpha

MeSH Terms

Adult
Biopsy
Etanercept*
Glomerulonephritis, IGA*
Hematuria
Humans
Immunoglobulin A*
Joints
Kidney
Male
Necrosis
Proteinuria
Skin
Spondylitis, Ankylosing*
Tumor Necrosis Factor-alpha
Etanercept
Immunoglobulin A
Tumor Necrosis Factor-alpha

Figure

  • Fig. 1 Plain radiographs of the SI joint demonstrating grade 2 bilateral sacroiliitis. The film shows mild subchondral sclerosis and irregularities of the joint surfaces in both SI joints.

  • Fig. 2 (A) Light microscopy of a glomerulus demonstrating expansion of the mesangial matrix with mesangial hypercellularity (hematoxylin-eosin stain, ×400). (B) Immunofluorescence microscopy demonstrating anti-IgA intense staining within glomerular mesangium (fluorescence microscopy, ×400).


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