A Case of Bio-Dissimilarity: Rapidly Progressive Glomerulonephritis Following Switch From Infliximab to Infliximab-abda
Document Type
Article
Publication Title
American Journal of Kidney Diseases
Abstract
Rapidly progressive glomerulonephritis is an uncommon but fulminant cause of acute kidney injury that requires urgent diagnosis and immunosuppression to prevent permanent kidney failure. We present a rare case of ANCA-negative pauci-immune crescentic glomerulonephritis occurring within weeks of transitioning from infliximab to the biosimilar infliximab-abda in a patient who had maintained years of complete stability on originator therapy, used for psoriasis. Although tumor necrosis factor-α inhibitors have been associated with paradoxical autoimmune phenomena, reported renal complications typically involve immune-complex glomerulonephritis, lupus-like nephritis, or ANCA-associated vasculitis, often accompanied by new autoantibody formation. The absence of serologic abnormalities, combined with the abrupt onset following biosimilar substitution, suggests a unique tolerance-breaking mechanism potentially driven by differences between biosimilars in higher-order protein structure or glycosylation. This case underscores the importance of recognizing that biosimilars, while highly similar to their reference products, may differ subtly in manufacturing-dependent attributes that influence immunogenicity in susceptible individuals. Clinicians should maintain vigilance for renal complications following biosimilar switches, particularly in patients with underlying autoimmune disease. Early biopsy confirmation and prompt initiation of immunosuppression remain essential to optimize renal recovery.
DOI
10.1053/j.ajkd.2026.06.036
Publication Date
10-31-2026
Keywords
ANCA-negative vasculitis, Acute kidney injury, Anti–TNF-α therapy, Biosimilar, Biosimilar immunogenicity, Crescentic glomerulonephritis, Drug-induced glomerulonephritis, Immune-mediated renal injury, Infliximab, Infliximab-abda, Pauci-immune crescentic glomerulonephritis, Rapidly progressive glomerulonephritis, Remicade, Renflexis
ISSN
1523-6838
Recommended Citation
Bowers W, Garcia E, Wood N, Cater K, Barry M, Jones J. A Case of Bio-Dissimilarity: Rapidly Progressive Glomerulonephritis Following Switch From Infliximab to Infliximab-abda. American Journal of Kidney Diseases. 2026; . doi: 10.1053/j.ajkd.2026.06.036.
