ブシラミンの腎毒性

Abstract

Bucillamine [N- (2-mercapto-2-methylpropanoyl) -L-cysteine, Rimatil (R) ] is a new slow-acting antirheumatic drug developed in Japan. The chemical structure of Bucillamine is similar to that of D-penicillamine except that it has two rather than one SH-bond in the molecule. As it is generally accepted that the SH-bond plays a role in the antirheumatic effect of D-penicillamine, the effectiveness of Bucillamine on rheumatoid arthritis has been proved in several studies.We administerd Bucillamine to 87 cases of rheumatoid arthritis patients for about 5 years, during which it became apparent that Bucillamine has the nephrotoxic potential to cause proteinuria. The frequency of bucillamine-induced proteinuria reached 12.6% in our study. Males were more susceptible to proteinuria than females (20.0% vs 11.1%), but its occurrence was not related with the dosage of bucillamine, disease duration, or the anatomical stage of disease.Other side effects, such as eruptions, itching, oral aphtha, malaise, and dysgeusia, also occurred, but no patient with proteinuria showed skin symptoms and/or dysgeusia.As bucillamine has the potential to cause proteinuria, similar to other antirheumatic drugs such as D-penicillamine and gold, special attention must be paid to renal involvement.