Adalimumab-induced IgA nephropathy

BMJ Case Rep. 2019 Mar 31;12(3):e226442. doi: 10.1136/bcr-2018-226442.

Abstract

Immunoglobulin A nephropathy (IgAN) is the most commonly diagnosed glomerulonephritis worldwide. It is usually idiopathic and may be associated with many other diseases. Recently, biological agents including tumour necrosis factor alpha (TNFα) inhibitors have been identified as a potential cause for IgAN. We report the case of a 39-year-old woman who presented with renal dysfunction and visible haematuria. She had a background of Crohn's disease (CD) and had been on adalimumab for 4 years following a right hemicolectomy. Subsequently, she underwent a renal biopsy that demonstrated IgAN and adalimumab was ceased. Following a flare in her CD, she was commenced on infliximab, which led to remission of the IgAN and CD. This is the first case to demonstrate the occurrence of IgAN as a complication of a TNFα inhibitor (adalimumab) that remained in remission despite the commencement of a second TNFα inhibitor (infliximab).

Keywords: crohn’s disease; drug interactions; drugs: gastrointestinal system; inflammatory bowel disease; unwanted effects/adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Adalimumab / adverse effects*
  • Adalimumab / therapeutic use
  • Adult
  • Biopsy
  • Colectomy
  • Crohn Disease / drug therapy
  • Crohn Disease / physiopathology
  • Crohn Disease / surgery*
  • Female
  • Gastrointestinal Agents / therapeutic use*
  • Glomerulonephritis, IGA / chemically induced*
  • Glomerulonephritis, IGA / pathology
  • Humans
  • Infliximab / therapeutic use*
  • Kidney Function Tests
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Gastrointestinal Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab