Tocilizumab prevents renal function of a patient with diabetic kidney disease: case report

AbstractDiabetic kidney disease (DKD) is the major cause of end stage renal disease. Despite the best current treatment, it is difficult to stop the progression of DKD. We report a 77-year-old Japanese man in whom rheumatoid arthritis (RA) was diagnosed at the age of 30 years, followed by type 2 diabetes mellitus (T2DM) at age 55. His haemoglobin A1c (HbA1c) was around 7–9%, even after starting insulin therapy. His renal function deteriorated steadily, with the estimated glomerular filtration rate (eGFR) decreasing by 2 mL/min/1.73 m2 per year to reach 29 mL/min/1.73 m2 (consistent with stage IV diabetic kidney disease) at age 69. Because RA was poor controlled with a DAS28-ESR of 4.46, HAQ of 0.375, and SDAI of 8.6, treatment with tocilizumab (an interleukin-6 receptor antibody) was initiated. Thereafter, control of RA improved, but HbA1c stayed in the range of 7–9%. However, eGFR remained around 30 ml/min/1.73 m2 even after 8 years. This case indicates that interleukin-6 might contribute to exacerbation...