IgAN Following Certolizumab Use

Introduction: IgA nephropathy (IgAN) is a leading cause of glomerulonephritis and is associated with hematuria, proteinuria, and progressive renal impairment. The link between TNF-alpha inhibitors and renal diseases, including IgAN, has been increasingly reported. Case Description: We present a case of a 70-year-old male with rheumatoid arthritis (RA) who developed IgAN and acute interstitial nephritis (AIN) following the initiation of certolizumab therapy after experiencing a motor vehicle accident (MVA). A 70-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and RA was started on certolizumab for RA management. He presented after a MVA that resulted in a sternal fracture. Nephrology consultation was prompted by an increase in serum creatinine from 1.04 mg/dL to 5.1 mg/dL. Laboratory evaluation revealed hematuria, proteinuria, and elevated free light chains with a normal ratio. Renal ultrasound showed no evidence of obstruction. A full GN workup was negative. Renal biopsy demonstrated IgAN with a cellular crescent and AIN, with interstitial fibrosis and tubular atrophy of 10–15%. He was treated with pulse steroids followed by a prednisone taper. Anti-certolizumab antibody levels were elevated (1773 ng/mL), subsequently trending down with treatment. The temporal association between certolizumab initiation and renal dysfunction suggests a potential link to IgAN and AIN, supported by the decline in anti-certolizumab antibodies paralleling improvements in renal function, although proteinuria persisted. Discussion: TNF-alpha inhibitors (TNF-ai) have been infrequently associated with GN and other renal pathologies, highlighting the need for awareness in susceptible patients. This case underscores the importance of monitoring renal function in patients receiving TNF-ai, especially when presenting with acute renal injury. IgAN should be considered in the differential for hematuria and proteinuria following TNF-ai or trauma. Early recognition and biopsy are critical for diagnosis and management.Correlation of Certolizumab antibody level with Creatinine trend