Renal damage in rheumatoid arthritis refers to a group of diseases caused by rheumatoid arthritis, including acute and chronic interstitial nephritis, renal amyloidosis, necrotizing vasculitis of the kidney, and immune complex nephritis, accompanied by corresponding clinical manifestations.

bubble_chart Diagnosis

1. Medical History and Symptoms

There is a history of chronic, multiple joint synovitis, manifested as fever, stiffness, redness, swelling, deformation, and dysfunction of the hands, feet, and limb joints. Some patients rapidly experience aggravated kidney damage when using non-steroidal anti-inflammatory drugs or gold preparations, presenting as nephrotic syndrome, chronic nephritis syndrome, or even acute renal failure. If the medication is discontinued promptly and appropriate measures are taken early, recovery to a relatively good condition is possible. Some patients develop direct chronic kidney damage or combined immune-mediated kidney damage due to long-term use of the aforementioned drugs, leading to varying degrees of proteinuria and microscopic hematuria. Some patients may exhibit edema, hypertension, and renal dysfunction, while increased nocturia often suggests chronic interstitial nephritis. Secondary renal amyloidosis or necrotizing vasculitis results in severe kidney damage, often progressing to chronic kidney failure.

2. Physical Examination Findings

Presence or absence of hypertension and edema, often with joint redness, swelling, deformation, and dysfunction; some may have subcutaneous wind-dampness nodules.

3. Auxiliary Examinations

(1) Urinalysis shows varying degrees of proteinuria or hematuria.

(2) Renal function may be normal or exhibit varying degrees of abnormalities; chronic interstitial nephritis primarily presents with impaired urine concentration.

(3) Elevated erythrocyte sedimentation rate, positive rheumatoid factor, and decreased serum complement C3 in a few patients.

(4) Renal biopsy can determine the nature and extent of the lesions.

4. Differential Diagnosis

This condition should be distinguished from kidney damage caused by other connective tissue diseases, such as systemic lupus erythematosus, mixed connective tissue disease, and wind-dampness arthritis. It should also be differentiated from kidney damage caused by primary small vessel vasculitis or pain wind.

First, the primary disease should be actively treated. When false Chinese swertia herb has already caused kidney damage, it should be discontinued and replaced with Chinese medicinals, physiotherapy, and physical therapy, which do not harm the kidneys. Kidney lesions can be treated based on clinical manifestations and pathological changes, following the treatment protocols for primary glomerulonephritis and renal failure.