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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "330" "paginaFinal" => "331" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Oktay Bagdatoglu, Yuksel Maras, Ozlem Yayar, Baris Eser" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Oktay" "apellidos" => "Bagdatoglu" "email" => array:1 [ 0 => "ozlemderen2@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Yuksel" "apellidos" => "Maras" "email" => array:1 [ 0 => "ymaras@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Ozlem" "apellidos" => "Yayar" "email" => array:1 [ 0 => "ozlemderen@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:4 [ "nombre" => "Baris" "apellidos" => "Eser" "email" => array:1 [ 0 => "beser374@mynet.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Nephrology Department, Ankara Ataturk Research and Training Hospital , Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Rheumatology Department, Ankara Ataturk Research and Training Hospital, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Nephrology Department, Corum Hitit University, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un nefropatía membranosa Caso: ¿Está relacionado con sulfasalazina?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In adult age group, the cause of membranous glomerulonephritis (MG) cannot be detected in about 75% of the patients. These cases are defined as idiopathic (primary) MG. MG associated with drugs and other diseases are defined as secondary MG.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Penicillamine and gold salts, formerly used in the treatment of rheumatoid arthritis (RA), are responsible for the development of MG. Amyloidosis, analgesic nephropathy, glomerulonephritis and rheumatoid vasculitis can be observed in RA.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the literature sulfasalazine was reported to cause interstitial nephritis, nephrotic syndrome, acute renal failure, non-nephrotic proteinuria, hematuria, and leucocyturia.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–4</span></a> Sulfasalazine 2000<span class="elsevierStyleHsp" style=""></span>mg/day, hydroxychloroquine, prednisolone 5<span class="elsevierStyleHsp" style=""></span>mg/day was started for a 55 year old non-diabetic man who was diagnosed as rheumatoid arthritis a year ago. He did not have a history of nonsteroidal antiinflamatory drug use. Proteinuria was detected a month later. Daily protein excretion was 14,725<span class="elsevierStyleHsp" style=""></span>mg/day and serum albumin was 2.8<span class="elsevierStyleHsp" style=""></span>g/dl. On physical examination, the patient was normotensive and had pitting oedema in his legs. The patient's blood urea nitrogen and creatinine level and C3, C4 was in normal range and HBsAg, AntiHCV, p-ANCA and c-ANCA was found to be negative. ANA was positive, but anti-ds DNA was found to be negative. Duodenal biopsy was negative for amyloid and percutaneous kidney biopsy was performed. In light microscopic examination, mild thickening of the glomerular basement membrane, mild interstitial inflammatory cell infiltration and hyaline material accumulation in some tubular spaces was observed. By immunofluorescence microscopy strong linear/granular IgG and complement deposition and mild granular, C3, C1q and kappa deposition in glomerular basal membranes was detected. These pathological findings suggested the diagnosis of membranous glomerulonephritis anti-phospholipase A2 receptor antibodies were negative. Considering this condition to be related to sulfasalazine, treatment was dropped out and prednisolone dosage was increased as 20<span class="elsevierStyleHsp" style=""></span>mg/day. In follow-up, two months later, 24-h urine protein excretion was found to be 389<span class="elsevierStyleHsp" style=""></span>mg/day and steroid dosage was tapered gradually. He is now being followed without proteinuria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although rare, case reports blaming sulfasalazine in the pathogenesis of parenchymal kidney injury, exist. Nevertheless, the US FDA placed a warning within the prescribing information for mesalazine products that stated “It is recommended that all patients have an evaluation of renal function prior to initiation of therapy and periodically while on treatment”.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">5-Aminosalicylate (5-ASA) is blamed for the nephrotoxicity of these drugs. Nephrotoxicity is thought to be idiosyncratic rather than dose-related.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Cases reported in the literature were mainly in the form of progressive interstitial nephritis. Following cessation of treatment, improvement of renal function can be observed in some cases, while steroid treatment can be indicated if improvement is not observed.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a cohort of ulcerative colitis 6 patients were reported to develop nephrotic syndrome. 3 of these patients were using mesalasine while 2 were using sulfasalazine and one patient was using both. In histological evaluation of the patients, 5 had minimal change disease and one patient had focal segmental glomerulosclerosis. All of the patients improved with steroid treatment.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> The pathogenesis of nephrotic syndrome associated with the use of sulfasalazine is not understood yet.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was also using hydroxychloroquine. This drug continued and remission of proteinuria existed, so the cause is not probably this drug. Also rheumatologic diseases can cause MN but proteinuria remission after discontinuation of the drug excluded this possibility.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our case, the histopathologic diagnosis was membranous glomerulonephritis and this varies from case reports in the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Drugs are one of the important causes of secondary membranous glomerulonephritis. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 4 | 0 | 4 |
2024 October | 72 | 34 | 106 |
2024 September | 70 | 23 | 93 |
2024 August | 80 | 48 | 128 |
2024 July | 75 | 34 | 109 |
2024 June | 58 | 28 | 86 |
2024 May | 72 | 31 | 103 |
2024 April | 67 | 35 | 102 |
2024 March | 68 | 22 | 90 |
2024 February | 79 | 33 | 112 |
2024 January | 47 | 24 | 71 |
2023 December | 49 | 30 | 79 |
2023 November | 56 | 38 | 94 |
2023 October | 90 | 36 | 126 |
2023 September | 52 | 31 | 83 |
2023 August | 58 | 23 | 81 |
2023 July | 73 | 29 | 102 |
2023 June | 63 | 16 | 79 |
2023 May | 83 | 36 | 119 |
2023 April | 60 | 16 | 76 |
2023 March | 69 | 24 | 93 |
2023 February | 61 | 20 | 81 |
2023 January | 54 | 19 | 73 |
2022 December | 82 | 31 | 113 |
2022 November | 76 | 32 | 108 |
2022 October | 82 | 44 | 126 |
2022 September | 64 | 28 | 92 |
2022 August | 83 | 44 | 127 |
2022 July | 53 | 39 | 92 |
2022 June | 54 | 35 | 89 |
2022 May | 67 | 39 | 106 |
2022 April | 51 | 43 | 94 |
2022 March | 69 | 58 | 127 |
2022 February | 79 | 48 | 127 |
2022 January | 76 | 35 | 111 |
2021 December | 56 | 36 | 92 |
2021 November | 54 | 36 | 90 |
2021 October | 284 | 26 | 310 |
2021 September | 136 | 34 | 170 |
2021 August | 38 | 38 | 76 |
2021 July | 54 | 38 | 92 |
2021 June | 46 | 25 | 71 |
2021 May | 43 | 37 | 80 |
2021 April | 123 | 46 | 169 |
2021 March | 82 | 38 | 120 |
2021 February | 61 | 36 | 97 |
2021 January | 44 | 18 | 62 |
2020 December | 35 | 22 | 57 |
2020 November | 45 | 22 | 67 |
2020 October | 35 | 19 | 54 |
2020 September | 32 | 14 | 46 |
2020 August | 55 | 22 | 77 |
2020 July | 31 | 15 | 46 |
2020 June | 45 | 25 | 70 |
2020 May | 50 | 12 | 62 |
2020 April | 31 | 21 | 52 |
2020 March | 52 | 16 | 68 |
2020 February | 51 | 21 | 72 |
2020 January | 61 | 29 | 90 |
2019 December | 50 | 24 | 74 |
2019 November | 43 | 23 | 66 |
2019 October | 43 | 14 | 57 |
2019 September | 38 | 14 | 52 |
2019 August | 32 | 23 | 55 |
2019 July | 26 | 24 | 50 |
2019 June | 41 | 16 | 57 |
2019 May | 37 | 22 | 59 |
2019 April | 60 | 23 | 83 |
2019 March | 31 | 15 | 46 |
2019 February | 33 | 23 | 56 |
2019 January | 37 | 15 | 52 |
2018 December | 105 | 37 | 142 |
2018 November | 265 | 21 | 286 |
2018 October | 164 | 19 | 183 |
2018 September | 62 | 14 | 76 |
2018 August | 47 | 19 | 66 |
2018 July | 39 | 9 | 48 |
2018 June | 51 | 19 | 70 |
2018 May | 54 | 12 | 66 |
2018 April | 79 | 13 | 92 |
2018 March | 68 | 8 | 76 |
2018 February | 60 | 6 | 66 |
2018 January | 57 | 7 | 64 |
2017 December | 48 | 6 | 54 |
2017 November | 39 | 11 | 50 |
2017 October | 34 | 6 | 40 |
2017 September | 42 | 10 | 52 |
2017 August | 28 | 10 | 38 |
2017 July | 36 | 10 | 46 |
2017 June | 33 | 20 | 53 |
2017 May | 41 | 13 | 54 |
2017 April | 44 | 12 | 56 |
2017 March | 20 | 23 | 43 |
2017 February | 22 | 8 | 30 |
2017 January | 17 | 9 | 26 |
2016 December | 28 | 5 | 33 |
2016 November | 41 | 17 | 58 |
2016 October | 56 | 6 | 62 |
2016 September | 105 | 5 | 110 |