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Adalimumab (Humira) is a tumour necrosis factor α (TNFα) inhibitor that is approved for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn's disease, ankylosing spondylitis, and juvenile idiopathic arthritis (Sullivan and Preda (2009), Klinkhoff (2004), and Medicare Australia). Use of TNFα inhibitors is associated with the induction of autoimmunity (systemic lupus erythematosus, vasculitis, and sarcoidosis or sarcoid-like granulomas) (Ramos-Casals et al. (2010)). We report a patient with extensive psoriasis presenting with renal failure and seropositive lupus markers without classical lupus nephritis after 18 months treatment with adalimumab. He has renal biopsy proven IgA nephritis instead. Renal biopsy is the key diagnostic tool in patients presenting with adalimumab induced nephritis and renal failure. He made a remarkable recovery after adalimumab cessation and steroid treatment. To our knowledge, this is a unique case of a psoriasis patient presenting with seropositive lupus markers without classical lupus nephritis renal failure and had renal biopsy proven IgA glomerulonephritis after receiving adalimumab.

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The occurrence of glomerular capillary aneurysms in light-chain nephropathy and a morphologic pattern of development as determined by electron microscopy are described. Renal biopsies from 4 patients with nodular glomerulopathy were evaluated. Light-chain deposition in mesangium and capillary walls was associated with monocyte accumulation in capillaries. Loss of endothelial cell lining and disruption of mesangial anchoring points of basement membranes ensued, resulting in aneurysmal dilatation of the capillaries. The walls collapsed, and the aneurysms healed as a result of mesangial interposition, a process which, in combination with enlarging nodules, led to thickening and collapse of the walls and narrowing of the lumens. This study, in conjunction with review of photographs from previously published reports, indicates that glomerular aneurysms are a common feature of nodular light-chain glomerulopathy. It also emphasizes additional light-microscopic similarities between this glomerulopathy and nodular diabetic glomerulosclerosis.