[A meta-analysis of risk factors for multidrug-resistant tuberculosis in China].

Objective: To explore the main risk factors of multidrug-resistant tuberculosis (MDR-TB) in China and to provide evidence-based evidence for MDR-TB preventon and control. Methods: All relevant literatures were searched in thedatabases, such as Pubmed, Web of Science and CNKI, Wanfang, VIP and SinoMed from 2000 to 2021. Quality evaluation and data extraction were carried out, and then a meta-analysis was performed using Stata 16.0 software. Results: A total of 59 literatures (36 cross-sectional and 23 case-control) including 75 793 participants were included in this study, and meta-analysis results showed age (OR=1.27, 95%CI: 1.05-1.54), education level (OR=1.29, 95%CI: 1.02-1.65), positive sputum smear (OR=2.56, 95%CI: 1.09-6.04), pulmonary cavity (OR=1.99, 95%CI: 1.57-2.52), course of disease (OR=4.25, 95%CI: 1.95-9.30), history of tuberculosis treatment (OR=6.42,95%CI:5.40-7.63), treatment interruption (OR=2.81, 95%CI: 1.50-5.29), irregular medication (OR=5.02, 95%CI: 2.95-8.54), adverse drug reactions (OR=4.27, 95%CI: 2.22-8.19), combined chronic obstructive pulmonary disease (COPD) (OR=2.21, 95%CI: 1.45-3.37), tuberculosis exposure history (OR=1.99, 95%CI: 1.36-2.91), smoking history (OR=1.35, 95%CI: 1.09-1.66) and floating population (OR=1.60, 95%CI: 1.04-2.44) were associated with the occurrence of MDR-TB. Conclusions: The high risk groups were farmer, low education level, pulmonary cavity, long course of disease, history of tuberculosis treatment, treatment interruption, irregular medication, adverse drug reaction, co-COPD, contact history of tuberculosis, smoking history, rural residence, and floating population. We should pay attention to high-risk groups, strengthen management and take effective measures such as early screening, knowledge education on tuberculosis, standardized and personalized treatment and whole-course supervision.

[Intein-Mediated Protein trans-Splicing of the Recombinant Streptavidin on Magnetosomes].

When expressing streptavidin recombinant polypeptide on magnetosomes (called bacterial magnetic nanoparticles, or BMPs), the presence of endogenous bacterial biotin might be detrimental. In the study, the streptavidin monomer fragment (S1-116) was fused with the intein N-terminal (termed precursor S1-116-IN), and S1-116-IN was expressed in E. coli (BL21). Meanwhile, the SA117-160 fragment was fused with the C-terminal intein, and then this chimeric polypeptide was expressed on magnetosomes by fusion with magnetosome membrance protein MamF. In the in vitro protein splicing system, the purified engineered magnetosomes (BMP-SA117-160-IC) and the S1-116-IN precursor were mixed. Intein-mediated trans-splicing reaction was induced to produce the functional magnetic beads BMP-SA. Our results indicate that intein-mediated protein trans-splicing may lead to efficient synthesis of the recombinant streptavidin on the magnetosomes, showing its promising potential to produce other functional magnetic nanoparticles.

[Effects of LNG-IUS on sexual function and sexual quality in women of childbearing age].

Objective: To investigate the effects of levonorgestrel releasing intrauterine system (LNG-IUS) on sexual function and sexual quality in women of childbearing age. Methods: A total of 203 healthy women who were using IUD for long-term contraception were enrolled in the study. Among them, 130 were placed LNG-IUS as the study group and 73 were placed the copper intrauterine devices (Cu-IUDs) as the control group. The two groups were further divided into three subgroups by age. The basic information and questionnaires were adopted before and 2 years after using IUDs, including age, the time of using IUD, side-effects after using IUD, frequency and satisfaction of sex after using IUD. The Female Sexual Function Index (FSFI) was evaluated on 2 years after. Results: In the 30-39 age subgroup, the frequency of sex was significantly decreased after using LNG-IUS (P<0.05). Rests of the subgroup shows no significantly different in the frequency of sex (P>0.05). The sexual satisfaction in all subgroups also shows no significantly different before and after using IUDs (P>0.05). There was no significant difference in the individual score and total scores of FSFI between the study group and control group (P>0.05). Conclusion: The LNG-IUS has no adverse effects on female sexual function and sexual quality in the reproductive age.

[Clinical analysis of 3 cases of eosinophilic granulomatosis with polyangiitis].

Objective: To improve the clinical recognition of eosinophilic granulomatosis with polyangiitis(EGPA) in clinical manifestations, diagnosis and treatment. Methods: The clinical manifestations, pathological characteristic, imaging manifestations, diagnosis and the therapy of three patients with EGPA were presented. Results: These 3 patients had asthma-like symptoms and extrapulmonary manifestations of systemic vasculitis. They were 20, 40 and 44 years old. All of them were female.They denied exposure or contact. Chest radiographic examination showed that the most common features were nodule shadow and tree-in-bud in the lung. The pathological manifestation was characterized by hypereosinophilia, high total IgE(over 300 KU/L) and high CRP(over 14.1mg/L). The FeNO of 2 patients was over 100ppb. The ANCA of these 3 patients was negative. The pulmonary pathology was observed had eosinophil infiltration in the alveolar, interstitial and vessel for 3 cases. The clinical manifestations were nonspecific. All patients were treated by glucocorticoid and immune-inhibitor(alkylating agents or purine synthesis inhibitors) therapy. Because patients were complicated with other organs involved, they needed long-time treatment. Conclusions: This disease is diverse and complex, with a lack of pathognomonic symptoms. We should highly suspect eosinophilic granulomatosis with polyangiitis, when the patients present severe asthma and eosinophilia. Early detection, early treatment, and the prognosis could be better.

[Investigation of short-term resolution as a predictor of long-term cure of microvascular decompression in hemifacial spasm].

Objective: To investigate whether the short-term relief of spasm (within 7 days) after microvascular decompression (MVD) for hemifacial spasm (HFS) can be used as a prognostic factor of long-term outcome (>6 months). Methods: The clinical characteristics and follow-up data (completely recorded) of 159 patients who had HFS and underwent microvascular decompression surgery in the first Affiliated Hospital of Fujian Medical University from August 2008 to May 2016 were analyzed retrospectively. The collected data focus on symptom relief in a time course: immediately after MVD, 7 days after MVD and the last follow-up (>6 months) by using Cohen-Albert grading. Results: In a total of 159 patients underwent MVD were followed up for more than 6 months.Compared to persist spasm group within 7 days after MVD, the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD (P<0.05). The cure rate of MVD (y) and the number of days within 7 days of relief (x) were highly relevant, y=-0.707x(2)+ 9.724x+ 67.442 (P<0.05). By using univariate Logistic regression analysis, we found that the prognostic factors of long-term curative effect were the symptom scale immediately after MVD and the average symptom scale in the 7 days after MVD (P<0.001). The incidence of delayed cure was 41.5%(66/159). Conclusion: In the 7 days after MVD, at least 1 day of symptom remission can predict the cure of HFS.

Mur (MNS 10) screening with a novel loop-mediated isothermal amplification assay in Zhongshan, China.

BACKGROUND: The distribution of the Mur blood group antigen is 5-7% in the south of China, and a much higher prevalence is observed in some areas of the region. Anti-Mur can cause hemolytic disease of the newborn and severe transfusion reactions. OBJECTIVES: Genetic testing is more ideal than conventional serological tests because antibodies for detection are usually not available. METHODS: In this study, a novel loop-mediated isothermal amplification (LAMP) assay for the detection of Mur blood group antigen was established. RESULTS: Fifteen of 275 (5·5%) samples were confirmed by LAMP as Mur antigen positive. All the Mur antigen-positive samples were GP.Mur subtype which was confirmed with sequencing. CONCLUSION: The LAMP method has identical results with conventional serology method but more suitable for large-scale screening.

[Corneal biomechanical properties in keratoconic and normal eyes].

OBJECTIVE: To compare the corneal biomechanical properties of keratoconic and normal eyes, and to explore the changing characteristics in keratoconic eyes. METHODS: Case-control study. Thirty-two keratoconic subjects(41 eyes)and 41 subjects(41 eyes)with normal corneas were enrolled in this study. Scheimpflug noncontact tonometry(Corvis ST)was performed to measure the length of Appl 1(1st A length), velocity of Appl 1(Vin), length of Appl 2(2nd A length), velocity of Appl 2(Vout), deformation amplitude(DA), peak distance, and radius. Comparison of the biomechanical property values between the keratoconic and normal eyes was performed using One-Way ANOVA. Pearson or Spearman correlations were used to evaluate the relationship between corneal biomechanical properties and corneal morphology parameters. The areas under ROC curves of the biomechanical properties of Corvis ST were calculated. RESULTS: In the keratoconic group, the values of Vin, Vout, and DA were(0.201±0.268),(0.463±0.121), and(1.146±0.113)mm, respectively, which were obviously greater than the normal group[(0.151±0.017),(0.418±0.060), and(1.146 ± 0.113)mm, respectively; F=6.028, 20.724, 10.606, P=0.016, 0.000, 0.001]. The radius in the keratoconic eyes was(5.898 ± 0.976)mm, apparently shorter than the normal eyes[(7.012 ± 0.728)mm; F=5.277, P=0.023]. In the keratoconic eyes, there were significant correlations between the 1st A length, Vout, DA, radius and the thickness of the thinnest cornea(r=0.330,-0.490,-0.482, 0.676, P=0.035, 0.001, 0.001, 0.000). There were significant correlations between the DA, radius and the anterior surface refractive power Km(r=0.751,-0.528, P=0.044, 0.019). The Vin, Vout, DA, and radius had statistically significant correlations with the maximum posterior surface elevation(r=0.475,-0.552,-0.399, 0.273, P=0.021, 0.015, 0.001, 0.000). The areas under ROC curves of the radius, DA, Vout, and Vin were all greater than 0.9. CONCLUSIONS: There were obvious changes of corneal biomechanical properties in keratoconic eyes compared with normal eyes. The radius showed a better sensitivity for the change of corneal biomechanical properties and a major reference value for the diagnosis of keratoconus. (Chin J Ophthalmol, 2016, 52:669-673).

Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta-analysis of observational studies.

Although several epidemiological studies reported that maternal chronic hepatitis C virus (HCV) infection had significantly increased risk of undergoing adverse obstetrical and perinatal outcomes, studies on the relationship between HCV infection and risk of preterm birth (PTB) have yielded inconclusive and inconsistent results. Therefore, we conducted a meta-analysis to investigate the association between HCV infection and PTB. The electronic database was searched until 1 September 2014. Relevant studies reporting the association between HCV infection and the risk of PTB were included for further evaluation. Statistical analysis was performed using revmen 5.3 and stata 10.0. Nine studies involving 4186698 participants and 5218 HCV infection cases were included. A significant association between HCV infection and PTB was observed (odds ratio = 1.62, 95% CI 1.48-1.76, P < 0.001, fixed-effects model). Stratification according to maternal smoking/alcohol abuse, maternal drug abuse or coinfected with HBV and/or HIV matched groups still demonstrated that women with HCV infection had a high risk for PTB. Findings from our meta-analysis suggested that maternal HCV infection was significantly associated with an increased risk of PTB. In the future, pathophysiological studies are warranted to ascertain the causality and explore the possible biological mechanisms involved.

The prognostic value of circulating tumor DNA in patients with melanoma: A systematic review and meta-analysis.

BACKGROUND: Circulating tumor DNA (ctDNA) has been investigated as a potential prognostic biomarker to evaluate the therapeutic efficacy and disease progression in melanoma patients, yet results remain inconclusive. The purpose of this study was to illustrate the prognostic value of ctDNA in melanoma. OBJECTIVES: To describe the clinical prognostic value of ctDNA for melanoma patients. METHODS: Searched for eligible articles from Pubmed, Web of Science and Embase. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the association between ctDNA at baseline or during treatment and overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 9 articles were obtained, involving 617 melanoma patients. The pooled HRs revealed that compared with baseline undetectable ctDNA patients, detectable ctDNA was highly correlated with poor OS (HR 2.91, 95% CI: 2.22-3.82; p < 0.001) and PFS (HR 2.75, 95% CI: 1.98-3.83; p < 0.001). A meta-analysis of these adjusted HRs was performed and confirmed that ctDNA collected at baseline was associated with poorer OS/PFS (OS: HR 3.00, 95% CI 2.19-4.11, p < 0.001/PFS: HR 2.68, 95% CI 1.77-4.06, p < 0.001). During treatment, a significant association was shown between ctDNA and poorer OS/PFS (OS: HR 6.26, 95% CI 2.48-15.80, p < 0.001; PFS: HR 4.93, 95% CI 2.36-10.33, p < 0.001). CONCLUSION: Investigation and application of ctDNA will improve "liquid biopsy" and play a role in early prediction, monitoring disease progression and precise adjusting treatment strategies in melanoma patients.

Astragalosides modulates contractile function of toad gastrocnemius muscle.

Huangqi (Radix Astragali) is a well-known traditional Chinese herbal medicine, it is an effective treatment for consumptive disease, such as the common cold, diarrhea, fatigue and cardiac diseases. Astragalosides (AST) is the main component of Huangqi. The purpose of this study is to investigate the modulation effect of AST on the skeletal muscle contractile function. Our results showed that the toad gastrocnemius muscle contractile response was significantly increased after the use of AST (25 mg/L, bath for the isolated muscle), which produced a left-ward shift of the contractile force-stimulation intensity curve. Moreover, AST also prevented the repetitive stimulation-induced decrease in muscle contractile force and recovery amplitude of muscle contraction. These results demonstrate that AST can affect contractile performance of toad gastrocnemius muscle and contribute to skeletal muscle anti-fatigue.

Pattern of proteinuria in IgA nephritis by SDS-PAGE: clinical significance.

Of sixty patients with IgA nephritis, none had CRF at first examination, 13 developed CRF with creatinine above 1.6 mg/dl within 6 years. Among these patients who had analysis of proteinuria by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE), 31 patients had middle molecular weight (MMW) proteinuria alone (pattern 1), 10 had MMW and Low MW (LMW) or tubular proteinuria (pattern 2), 10 had high MW (HMW) and MMW proteinuria (Pattern 3) and 9 had HMW, MMW and LMW proteinuria (Pattern 4). At the end of a follow up period of 6 years (1983-1989) patients with mixed proteinuria had a higher incidence of chronic renal failure (CRF), 11/29 (38%) compared to those with pattern 1 proteinuria, 2/31 (6%) (chi 2 = 8.7, p less than 0.005). Based on the glomerular selectivity index (GSI), 19 patients had nonselective proteinuria but they did not have a higher incidence of CRF. By the selectivity index (SI), 18 patients had nonselective proteinuria and they showed a significantly higher incidence of CRF. Compared to the 41 patients who did not have LMW proteinuria, 19 patients with LMW proteinuria had more severe proteinuria. After a follow-up period of 6 years, patients with LMW proteinuria had a higher incidence of CRF (10% versus 47%, p less than 0.001). The presence of LMW proteinuria indicates a less favourable outcome and the pattern of proteinuria as assessed by the SDS-PAGE appears to be a better prognostic index in IgA nephritis than the SI and the GSI.

Use of hemodiafiltration to enhance delivered dialysis.

Patients on hemodialysis for end-stage renal disease frequently have increased levels of lipoproteins and beta-2 microglobulin (B2M). In an effort to assess the effect of hemodiafiltration on TACUrea, delivered Kt/VUrea, normalized protein catabolic rate, and B2M level, 6 chronic hemodialysis patients (mean age 63.3 +/- 17 years; 3 men, 3 women) were randomly selected to undergo 4 weeks of hemodiafiltration. The therapy consisted of Qb: 400 ml/min, Qd: 800 ml/min, time: 3.5 hours and 10 L hemofiltrate exchanges with either Ringer's lactate or combination of Ringer's solution and saline using polysulfone membrane dialyzer. TACUrea, Kt/VUrea delivered, normalized protein catabolic rate, serum electrolytes, liver enzymes, lipoproteins, and B2M clearance were evaluated before and after hemodiafiltration. Kt/V increased significantly [pre: 1.3 +/- 0.2 vs post: 1.8 +/- 0.3; p < 0.05], and TACUrea decreased (pre: 44.3 +/- 15 vs post 32 +/- 6.7 mg/dl; p < 0.1). There was no change in normalized protein catabolic rate (pre: 0.88 +/- 0.21 vs post: 0.80 +/- 0.15). B2M clearance was greatly enhanced (pre: 22 +/- 11 vs post: 110 +/- 36 ml/min; p < 0.001) together with a reduction in serum B2M level (pre: 43.6 +/- 11.4 vs 31.2 +/- 6.4 mg/L; p < 0.05). There was no significant increase in total cholesterol, low density lipoprotein, high density lipoprotein, or triglyceride levels, nor was there a change in electrolyte, CO2, or liver enzyme levels. Blood pressure control was satisfactory throughout hemodiafiltration therapy. Hemodiafiltration using a polysulfone membrane dialyzer raised delivered Kt/VUrea and reduced TACUrea and B2M levels significantly.

Pseudomonas pseudomallei pneumonia with septicemia--case report.

A case of Pseudomonas pseudomallei pneumonia with septicemia is described. The onset was insidious with paucity of systemic symptoms except fever. Diabetes mellitus and alcoholism were associated problems. Initially blood cultures were negative but subsequently P. pseudomallei was isolated. The outcome was fatal. Unless diagnosed early and treated appropriately, patients often succumb to septicemic shock.

Slow continuous ultrafiltration (SCUF)--the safe and efficient treatment for patients with cardiac failure and fluid overload.

Slow Continuous ultrafiltration (SCUF) was first used in 1980 as an alternative mode of fluid removal for patients with oliguric acute renal dysfunction from whatever causes. The advantage of this treatment is that haemodynamic parameters remain stable in the presence of significant removal of fluid. We are describing our experience in 7 patients [age: 57 +/- 9 years; 4 male, 3 female] with cardiac failure and fluid overload who had undergone 8 sessions of SCUF. All of them had renal impairment and were resistant to diuretics. Blood lines were attached to a Kawasumi Renak-E dialyser (Cuprophane membrane) in series using Gambro AK10 dialysis blood pump. The following parameters were monitored: Blood pump (Qb): 175 +/- 26 ml/min, time (T): 393 +/- minutes. Venous pressure averaged a55 +/- 24 mmHg. We achieved ultrafiltration of 2,189 +/- 699 ml/session or 5.5 +/- 1.7 ml/hr. There was no significant change in blood pressure [systolic pre: 143 +/- 14, post: 136 +/- 13 mmHg, not significant; diastolic pre: 87 +/- 10, post: 83 + 10 mmHg, not significant and pulse rate [pre: 87 +/- 9 vs post: 84 +/- 2 per minute, not significant. Heparin dosage averaged 274 +/- 26 IU/hr during the SCUF. We conclude that SCUF is beneficial to diuretic resistant patients with cardiac failure and fluid overload in whom dialysis treatment is not required.

Acute renal failure prognostic indices in hospital inpatients referred for haemodialysis.

Forty-eight patients with acute renal failure (ARF) who were referred to the Department of Renal Medicine, Singapore General Hospital for acute dialysis between August 1985 and August 1989 were studied retrospectively to identify risk factors associated with ARF that serve as prognostic indicators. There was no difference in the mean age of survivors and non-survivors (49.5 +/- 17.5 years vs 53.5 +/- 18 years, p greater than 0.05). The overall mortality rate was 52%. ARF as a result of surgical complication had a higher mortality rate in comparison to ARF from medical complications (66% vs 50%, p greater than 0.05). Septicaemia was the most common cause of ARF requiring dialysis. Hepatobiliary sepsis was the most frequent cause of septicaemia. Pre-dialysis serum urea and creatinine levels, and the number of dialysis treatments did not affect the outcome. Poor prognostic indicators included oliguria or anuria, fluid overload and coma. Patients tended to have a worse outcome if they had more than three risk factors taken from the following list:-decreased renal perfusion, assisted ventilation, coma, gastrointestinal dysfunction, recent surgery, sepsis, congestive heart failure, hepatobiliary dysfunction, malignancy, diabetes mellitus, chronic renal insufficiency and poor nutritional status. Early referral of patients with septicaemia due in particular to hepatobiliary infection may improve the prognosis.

Continuous ambulatory peritoneal dialysis in type II diabetics.

Forty-two Type II diabetic patients with end stage renal failure who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis (CAPD) for a period of two to 48 months (average 16.8 months) with a total experience of 640 patient-months. Of the 42 patients, 29 (69%) were male and 13 (31%) were female. The mean duration of diabetes before dialysis was 12 years. Eleven patients (40%) were on dietary control alone, seven patients (24%) on oral hypoglycaemic control and ten patients (36%) on insulin treatment. Blood glucose control between these groups did not differ significantly. There was a significant gain in dry weight from a mean of 60.3 kg prior to dialysis to 74 kg two years after dialysis. There was no significant improvement in the haemoglobin level. Blood triglyceride levels increased from 214 +/- 63 mgm/dl to 283 mgm +/- 156 mgm/dl with an insignificant reduction in the cholesterol level. Serum calcium levels increased significantly from 8.0 +/- 1.3 to 9.1 +/- 1.0 mgm/dl in 12 months (p < 0.05). Serum alkaline phosphatase level remained stable. Blood pressure was stable throughout the dialysis period. Adequacy of dialysis clearance was shown by the mean value of serum urea 115 +/- 40 mgm/dl, serum creatinine 10.6 +/- 2.7 mgm/dl and serum phosphate 4.65 +/- 1.6 mgm/dl after two years on CAPD. No peritoneal membrane failure was reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytomegalovirus infection in renal transplant patients with hepatitis B--case report.

Cytomegalovirus (CMV) infection in Hepatitis B carrier renal transplant patients who are immunosuppressed can be easily overlooked especially in those presenting with jaundice and liver failure. Recognising hepatitis due to CMV in renal transplant patients who are also hepatitis B carriers is important therapeutically as measures for the treatment and prevention of CMV infection are already available. This is especially so as Hepatitis B has a moderately high prevalence in this part of the world. We describe our clinical experience of cytomegalovirus infection in two renal transplant patients who are also asymptomatic hepatitis B carriers.

The risk of placental abruption and placenta previa in pregnant women with chronic hepatitis B viral infection: a systematic review and meta-analysis.

INTRODUCTION: Several epidemiological studies have found a positive association between chronic hepatitis B virus (CHB) infection and the risk of placental abruption and placenta previa, but various studies have reported conflicting findings. The objective was to systematically review the literature to determine a possible association between CHB infection and these two placental complications. METHODS: We conducted a computerized search in electronic database through March 1, 2014, supplemented with a manual search of reference lists, to identify original published research on placental abruption and placenta previa rates in women with CHB infection. Data were independently extracted, and relative risks were calculated. The meta-analysis was performed using Stata version 10.0 software. RESULTS: Five studies involving 9088 placenta previa cases were identified. No significant association between CHB infection and placenta previa was identified (OR = 0.98, 95% CI = 0.60-1.62). Five studies involving 15571 placental abruption cases were identified. No significant association between CHB infection and placental abruption was identified (OR = 1.42, 95% CI, 0.93-2.15). DISCUSSION: The immune response against the virus represents a key factor in determining infection outcomes. No observation of significant increased risk of the placental complications could be partially explained by the complex immune response during CHB infection. CONCLUSIONS: Our meta-analysis found no evidence of significant associations between CHB infection and increased risk of placental abruption as well as placenta previa. Further well-designed studies were warranted to assess any potential association between CHB infection and increased risk of placental abruption as well as placenta previa.

Adalimumab (TNF α Inhibitor) Therapy Exacerbates IgA Glomerulonephritis Acute Renal Injury and Induces Lupus Autoantibodies in a Psoriasis Patient.

Adalimumab (Humira) is a tumour necrosis factor α (TNF α ) 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 TNF α 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.