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Abstract
[1] Thereafter, a low dose of prednisone, oral methotrexate (15 mg/week) and intermittent administration of nonsteroidal anti-inflammatory drugs (NSAIDs) were initiated. Because of tenderness of multiple joints and new occurrence of rheumatoid nodules on the left knee on 16 February 2014, and erythrocyte sedimentation rate (ESR) increased to 70 mm/h and C-reactive protein (CRP) 16.3 mg/L, with a high disease activity score for 28 joints (DAS28) scored 5.44, adalimumab (40 mg subcutaneous every other week) was initiated. Laboratory findings showed elevated white blood cell count, 15.72 × 10 9 /L (normal range: 4.0-10.0 × 10 9 /L); hemoglobin, 90 g/L (120-160); platelets, 232 × 10 9 /L (normal range: 100-300 × 10 9 /L); serum urea nitrogen, 31.84 mmol/L (normal range: 1.07-7.14 mmol/L); serum creatinine (Cr), 249 μmol/L (normal range: 45-84 μmol/L); urinary protein excretion was 5.41 g/24 h, and calculated eGFR was 23 mlmin-11.73 m-2. [...]crescentic IgA nephritis was diagnosed. [...]proteinuria decreased to 1.42 g/24 h, but the serum Cr increased to 709 μmol/L, and renal replacement therapy with hemodialysis was started 3 times/week. RA is an autoimmune systemic disease, and the most common renal disorders associated with RA or drugs used in treatment such as NSAIDs and disease-modifying antirheumatic drugs (DMARDs) are secondary amyloidosis, rheumatoid vasculitis, analgesic nephropathy and drug-induced membranous nephropathy, especially gold salt and penicillamine; [2] however, IgA nephritis associated with RA was quite rare and there are no reports of crescentic IgA nephritis secondary to the use of NSAIDs or DMARDs. [...]crescentic IgA nephritis should...