Acute or progressive impairment of kidney function in patients with immune-mediated inflammatory rheumatic diseases

Acute or progressive deterioration of kidney function in rheumatic diseases can be due to rapidly progressive glomerulonephritis (ANCA-associated vasculitis, anti-GBM disease, other vasculitides, systemic lupus erythematosus), thrombotic microangiopathy (primary and secondary antiphospholipid syndrome) and drug induced acute kidney injury (tubular necrosis that can be due to changes in the intraglomerular hemodynamics or direct drug toxicity, acute interstitial nephritis). Less common causes include renal vasculopathy (scleroderma renal crisis), acute interstitial nephritis in Sjogren syndrome or IgG4-associated disease, rabdomyolysis (myoglobinuria) in idiopathic inflammatory myopathies, acute urate nephropathy, renal artery or vein thrombosis in antiphospholipid syndrome. Serological tests (eg. ANCA, anti-GBM antibodies, antiphospholipid antibodies, cryoglobulins, antinuclear antibodies, etc.) and kidney biopsy are essential for differential diagnosis of potential causes of kidney dysfunction.

Key words

Immune-mediated inflammatory rheumatic diseases, acute kidney injury, acute kidney disease, rapidly progressive glomerulonephritis.