Atteintes rénales dans les spondyloarthrites

Abstract

Nephropathy is one of the extra-articular manifestations associated with spondyloarthritis (SpA), and is observed in up to 6 % of all patients. In historical series, AA amyloidosis, secondary to the chronic inflammatory syndrome, was the most frequent cause of renal disease encountered in this setting. The use of TNF blockers therapies and early diagnosis of the rheumatic disease has induced a significant decrease in the incidence of amyloidosis in Europe, but this renal complication remains one of the main concerns in other populations, being responsible for nephrotic syndrome, rapidly progressive renal failure and chronic dialysis. IgA nephropathy (IgAN) is the second major type of glomerulopathy associated with SpA. In most cases, IgAN is revealed by asymptomatic hypertension, proteinuria and/or haematuria but this silent nephropathy can sometimes progress to end-stage renal disease (ESRD) despite anti-inflammatory treatment with anti-TNF drugs or corticosteroids. Finally, several nephrotoxic drugs are prescribed to SpA patients, such as NSAID, which may deteriorate renal function. Systematic and regular screening of kidney disease, including blood pressure monitoring, serum creatinine measurement and urine dipstick analysis, must be proposed to all SpA patients. Confirmation of chronic kidney disease should lead to etiological investigations and initiation of nephroprotective therapy to stop progression towards ESRD.