Glomerulonephritis and psoriasis: Is this a psoriatic nephropathy or an accident? (short review AND Case Report)

Abstract

Association psoriasis with kidney diseases has been debated for a long time. Drug induced renal lesions due to nonsteroidal anti inflammatory drugs, methotrexate or cyclosporine are accepted accompaniments of psoriasis. Secondary renal amyloidosis and IgA nephropathy are also known. They are rare and usually develop in patients with severe generalized forms of psoriasis and with psoriatic arthritis. The mesangioproliferative variant of glomerulonephritis is more common. Its pathogenesis is poorly understood. We reported a 35 year old Caucasian male with 15 years history of psoriasis vulgaris. Arthritis is suddenly developed during the exacerbation. Initially steroid unguent, indomethacin and diclofenac orally were used only. Psoriatic plaques began to resolve, but joints pain persisted. Arterial hypertension, proteinuria and erythrocyturia were identified in two months. The patient was diagnosed as IgA nephropathy and psoriatic arthritis concurrently according to medical history, physical examination, laboratory test, and pathology of renal biopsy. Intravenous methylprednisolone (500 mg/day thrice) and cyclophosphamide (600 mg/day once) were effective. Methylprednisolone (12 mg/day), allopurinol (100 mg/day), losartan (50 mg/day) also were administrated orally. The patient’s symptoms of psoriasis, arthritis and nephropathy improved, and he discharged from the hospital. We believe that psoriatic rather than secondary drug nephropathy has developed in this clinical case.