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Patients with rheumatoid arthritis are at a higher risk for developing kidney disease. This article outlines the connection between the two diseases.

Patients with arthritis can suffer from consequences that extend beyond their joints. Several different organ systems can be involved in the pathogenesis of arthritis, including the kidneys. Many studies suggest that patients with rheumatoid arthritis, a common subtype of arthritis, are at a higher risk for developing kidney disease. Additionally, there is a connection between kidney disease and heart disease. Thus, patients who have both kidney disease and rheumatoid arthritis are at even a greater risk for developing heart disease, which can be fatal.

The connection between rheumatoid arthritis and the kidneys

Several studies have investigated the connection between kidney disease and rheumatoid arthritis:

  • One study showed that people with rheumatoid arthritis have a 25 percent risk of developing kidney disease. On the other hand, people without rheumatoid arthritis have a 20 percent risk. Thus, there is a definite increased risk of kidney disease for patients with rheumatoid arthritis.
  • Another study of 129 French rheumatoid arthritis patients showed that 46 percent of their cohort had some extent of kidney disease.

Several theories explain the possible reasons behind the higher prevalence of kidney disease in rheumatoid arthritis patients. One study found that people with rheumatoid arthritis eventually develop a condition called amyloidosis, which refers to the deposition of a particular protein that can cause kidney failure. However, this is not the only connection, as studies have shown that rheumatoid arthritis patients can also develop other types of kidney disease besides kidney failure.

Unfortunately, it is not always known exactly which kidney disease patients develop because their clinical presentations are quite similar and doctors need to do a kidney biopsy to find out exactly what type of kidney disease the patient has. Researchers believe that the connection between the two diseases can be explained by:

  • An autoimmune inflammatory response
  • Treatments administered for rheumatoid arthritis
  • Shared risk factors

Let's take a closer look at what this means. 

Autoimmune inflammatory response and kidney disease

Rheumatoid arthritis is an autoimmune disease, characterized by inflammation caused by immune cells that have an impaired response to healthy tissue. As there is a relatively significant inflammatory burden in patients with arthritis, that can lead to kidney disease. Inflammation in the body affects several different organs. Therefore, just as rheumatoid arthritis is associated with inflammation of blood vessels, it is also associated with inflammation of blood vessels in the kidneys, leading to kidney disease.

Rheumatoid arthritis treatments and kidney disease

Some treatments that the doctor may prescribe for your rheumatoid arthritis can actually lead to an increase your risk of kidney disease, as they can have a lingering toxicity effect on the kidneys, despite the fact that most medicines for rheumatoid arthritis are not directly harmful to the kidneys. This is especially a problem for people who already have decreased kidney function.

These are four examples of drugs that are harmful to kidneys:

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. For healthy people, taking NSAIDs (once in a while) is not harmful. However, NSAIDs do decrease the amount of blood that goes to the kidney at a rate that is not detrimental to healthy individuals but it is to people who are older or already have reduced kidney function.
  2. Corticosteroids (such as prednisone). This type of drug is known to cause patients to retain fluid, which can lead to increased blood pressure over time. High blood pressure can lead to kidney disease.
  3. Methotrexate. This is another type of drug that is commonly prescribed to patients with arthritis. Unfortunately, methotrexate is removed from the body through the kidneys. Thus, if your kidneys are not healthy then the methotrexate can build up in the bloodstream, leading to an overdose.
  4. Cyclosporine. This is another type of drug that functions to suppress the immune system. It is thought to reduce kidney function.

What are the shared risk factors for kidney disease and rheumatoid arthritis?

Another connection between the two diseases is that they have shared risk factors. Thus, you should be even more careful if you have arthritis and characteristics that put you in a higher risk category for developing kidney disease. These risk factors include:

  • Comorbidities such as diabetes, heart disease, high blood pressure and high cholesterol
  • Family history
  • Race or ethnicity (African Americans are more likely to develop kidney disease)

The autoimmune inflammatory response, different types of treatments and shared risk factors are three strong connections between kidney disease and arthritis.

Symptoms of kidney disease rheumatoid arthritis patients should watch out for

If you have arthritis, you should be on the watch for potential symptoms of kidney disease. These include:

  • Fatigue or tiredness
  • Itchy skin
  • Dark skin
  • Reduced appetite
  • Cramps
  • Puffy eyes
  • Shortened breath
  • Swollen feet
  • Problems concentrating
  • Problems sleeping
  • Swollen ankles
  • Urinating frequently

So. what can you do?

There are several different ways to protect your kidneys:

  • Control your arthritis as that keeps the inflammation under control and protects your kidneys.
  • Discuss your medications with your doctor as some of your medications can cause kidney problems.
  • Simple blood work can tell you if your kidneys are functioning properly. Therefore, do these tests regularly in order to ensure that your kidneys are fine.
  • Keep your blood pressure and cholesterol in the healthy range, as patients with high blood pressure and cholesterol are more at a risk for developing kidney disease.
  • Drinks lots of fluid.
  • Don’t eat too much salt, as that places strain on your kidney.

  • De Man, Yael A., et al. "Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study." Arthritis Care & Research: Official Journal of the American College of Rheumatology 59.9 (2008): 1241-1248.
  • Lawson, A. A., and N. Maclean. "Renal disease and drug therapy in rheumatoid arthritis." Annals of the Rheumatic Diseases 25.5 (1966): 441.
  • Dember, Laura M. "Amyloidosis-associated kidney disease." Journal of the American Society of Nephrology 17.12 (2006): 3458-3471.
  • Photo courtesy of SteadyHealth

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