Features of renal involvement in systemic connective tissue diseases
Connective tissue diseases (CTDs) are a heterogeneous group of disorders that have certain clinical presentations and a disturbed immunoregulation, leading to autoantibody production. Subclinical or overt renal manifestations are frequently observed and complicate the clinical course of CTDs. Lesion of kidney function are typical for such CTDs as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjogren syndrome, autoimmune myopathies (dermatomyositis and polymyositis). At the present stage, considering the availability of many diagnostic manipulations and the possibility of etiopathogenetic treatment, therapists, rheumatologists and nephrologists must suspect in advance the presence of kidney disease in patients with CTD and assume measures for diagnosis and treatment. In systemic lupus erythematosus, renal prognosis is significantly improved based on specific classification and treatment strategies adjusted to kidney biopsy findings. One of the most severe kidney lesions is scleroderma renal crisis, which is usually characterized by severe hypertension, progressive decline of renal function and thrombotic microangiopathy. Early administration of angiotensin-converting enzyme inhibitors in these patients shows a significant benefit in particular and strict blood pressure control in general. Treatment of the underlying autoimmune disorder or discontinuation of specific therapeutic agents improves kidney function in most patients with Sjogren syndrome, autoimmune myopathies, and rheumatoid arthritis. On the other hand, chronic use of immunosuppressive agents and non-steroidal anti-inflammatory drugs, as well as comorbidities, such as diabetes, hypertension, and cardiovascular complications, are the main causes of renal involvement in patients with rheumatic diseases. Apart from this, long-standing primary kidney disease can lead to manifestations simulating primary rheumatologic disorders. In this review, we focus on impairment of renal function in relation to underlying disease or adverse drug effects and implications on treatment decisions.
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