TNF and chronic kidney disease: While some reports suggest no harmful effects or a slower decline in renal function with TNF-α inhibitors in CKD patients with rheumatoid arthritis, instances of acute kidney injury (AKI), focal segmental glomerulosclerosis, or IgA nephropathy have been reported in patients with ankylosing spondylitis, rheumatoid arthritis, or inflammatory bowel disease treated with TNF-α inhibitors [53, 229–233].