Renal involvement is one of the major adverse events of these drugs. It may vary from simple membranous nephropathy (Manabe S et al. 2015) to ANCA-associated aggressive nephritis and crescentic glomerulonephritis for both D-pencillamine and bucillamine (Bienaime F et al. 2007; Basterrechea MA 2004). High creatinine levels and persistence of proteinuria may indicate renal involvement and requires close monitoring. Early detection and prompt withdrawal of the drug is recommended to resolve proteinuria in patients with early course of the disease (Mokuda S et al. 2013). Whereas, management of ANCA-related nephritis should include administration of steroids, in addition to treatment discontinuation (Nanke et al. 1999). The renal involvement is often self-limiting or reversible, if detected early.

REFERENCES

1. Manabe S, Banno M, Nakano M, Fujii T, Fujiwara M, Kita Y, Nitta K, Hatano Bucillamine-induced membranous nephropathy with crescent formation in a patient with rheumatoid arthritis: case report and literature review. Case Rep Nephrol Dial, 2015. 5(1): p. 30-8.
2. Bienaimé F, Clerbaux G, Plaisier E, Mougenot B, Ronco P, Rougier JP. D- Penicillamine-induced ANCA-associated crescentic glomerulonephritis in Wilson Am J Kidney Dis, 2007. 50(5): p. 821-5.
3. Basterrechea MA, de Arriba G, García-Martin F, Sánchez-Heras M, Giménez- Vega E, Sánchez [Minimal changes nephrotic syndrome associated to penicillamine treatment]. Nefrologia, 2004. 24(2): p. 183-7.
4. Mokuda S, Onishi M, and Takasugi D- penicillamine- induced glomerulonephritis with crescent formation: Remission following drug discontinuation. Indian J Nephrol, 2013. 23(3): p. 226-8.
5. Nanke Y, Akama H, Terai C, Hara M, Kamatani [MPO-ANCA positive rapidly progressive glomerulonephritis in a patient with rheumatoid arthritis during treatment with D-penicillamine]. Nihon Rinsho Meneki Gakkai Kaishi, 1999. 22(5): p. 354-9.