Renal illness in patients with inflammatory bowel disease

Česká verzia

Authors: V. Teplan ^{1 4} ; Honsová E. ⁵; Lukáš M. ^1,2
Authors place of work: Klinické a výzkumné centrum pro idiopatické střevní záněty ISCARE I. V. F. a. s., Praha ¹; 1. LF UK, Praha ²; Subkatedra nefrologie, Institut postgraduálního vzdělávání ve zdravotnictví, Praha ³; Katedra interních oborů LF OU, Ostrava ⁴; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha ⁵
Published in the journal: Gastroent Hepatol 2020; 74(3): 256-266
Category: Chapters from internal medicine: Review Article
doi: https://doi.org/10.14735/amgh2020256

Summary

Gastrointestinal and renal diseases may occur simultaneously. Inflammatory bowel diseases (IBD) are typically accompanied with diarrhea and malabsorption, both of which are predisposing factors for the formation of renal calculi. Enteric hyperoxaluria is a frequent complication of IBD with ileal resection and is well known to cause nephrolithiasis and nephrocalcinosis. The excess of oxalate is primarily excreted by the kidneys. Increased urinary excretion of oxalate results in urinary calcium oxalate supersaturation, leading to crystal aggregation, urolithiasis, and/or nephrocalcinosis. Urinary complications in IBD patients with urolithiasis are infection of urinary tract, ureteral obstruction and fistulas. Potential nephrotoxic effect of long-term mesalasine (5-ASA) administration (toxoalergic or chronic nephrotoxic effect) is very important and can lead to tubulointerstitial nephritis, serious damage of renal function and, exceptionally, to renal failure. Therefore, it is recommended to control renal function and urine analysis in the beginning every 3 months, following by a 6-month control. Renal AA amyloidosis is also relatively frequent due to chronic bowel inflammation. Recently, great interest is focused on concomitant immunologic illnesses, mainly glomerulonephritides. The most frequent is mesangioproliferative glomerulopathy with IgA deposits (IgA nephropathy Berger). Acute glomerulonephritis accompanied with bowel inflammation can also occur. Renal damage is associated with decreased renal function (glomerulal filtration rate, concentration and acidification ability) and frequently also with proteinuria, sometimes even nephrotic. Specific situation occurs in IBD patients on biologic therapy and in those with simultaneous renal disease indicated for immunosuppresive treatment with corticosteroids and azathioprine.

Keywords:

inflammatory bowel disease – tubulointerstitial nephritis – glomerulopathy – urolithiasis

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