Nephrologic Involvement in Rheumatic Diseases

When considering kidney injury in the context of rheumatologic/connective tissue diseases (CTDs), systemic lupus erythematosus (SLE) and anti-neutrophil cytoplasmic antibody (ANCA)-mediated vasculitis immediately come to mind. Indeed, a great deal of attention and resources have been focused on lupus and ANCA-associated nephritis research. However, the kidney is a target in many autoimmune rheumatic diseases, often complicating management and increasing patient morbidity and mortality. Additionally, some of the medications used to treat CTD may adversely affect the kidney. It is therefore critical to evaluate the status of the kidney in all patients with CTD at diagnosis and regularly during treatment and follow-up. Early intervention is generally the best way to attenuate kidney injury and preserve functional renal mass to avoid chronic kidney disease (CKD) and progression to end-stage kidney disease (ESKD). This chapter will focus on the kidney complications known to occur in rheumatoid arthritis, Sjogren’s syndrome, systemic sclerosis, and the autoimmune myopathies.