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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(1): 62–67. doi:10.14735/amgh202062.

Glomerulopathies in patients with inflammatory bowel disease

Vladimír Teplan Orcid.org  1,2,3, Eva Honsová Orcid.org  4, Milan Lukáš Orcid.org  5

+ Affiliation

Summary

Inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis often accompany one another. Recently, the association between immunologic illness and IBD, mainly in patients with glomerulonephritis, has attracted considerable interest. The most frequent example is mesangio-proliferative glomerulopathy with immunoglobulin A deposits, which is referred to as IgA nephropathy (Berger’s disease). Renal damage often presents as decreased renal function and frequently results in proteinuria, a characteristic of nephrotic syndrome. Specific situation occurs in IBD patients on biologic therapy and simultaneous immune-mediated renal disease (glomerulopathies) which is indicated also for immunosuppressive treatment. Currently, the treatment strategy involves simultaneous administration of biologic anti-tumor necrosis factor (TNF) drugs and immunosuppressants, but this strategy is empiric because its use depends on the clinical and laboratory features of both diseases. In IBD patients with a non-advanced renal pathology, biologic therapy of IBD continues in the same manner. In adverse renal disease patients, a switch in therapy from infliximab to vedolizumab is an option. In the case of relapsed renal disease with increasing proteinuria, nephrologists recommend full intensive immunosuppressive therapy with e.g., cyclophospamid (Endoxan iv) and corticosteroids (Methylprednisolon iv). In these situations, an interruption of biologic therapy with anti-TNF drugs is mandatory to minimize immunosuppressive effects and the risk of serious infection. However, clear rules and confirmatory studies are not yet available. Four clinical cases from clinical practice are briefly introduced and discussed.

Keywords

biologic therapy, glomerulopathies, immunosuppression, kidney

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Literature

1. Teplan V, Marečková O, Lukáš M. Onemocnění gastrointestinálního traktu a choroby ledvin. Gastroent Hepatol 2018; 72 (1): 50–57. doi: 10.14735/amgh201850.
2. Marečková O. Poruchy gastrointestinálního traktu u chorob ledvin. In: Teplan V. Metabolismus a ledviny. Praha: Grada Avicenum 2000: 147–157.
3. Teplan V, Lukáš M. Urolithiasis in patients with inflammatory bowel disease. Gastroent Hepatol 2015; 69 (6): 561–569. doi: 10.14735/ amgh2015561.
4. Serra I, Oller B, Mañosa M et al. Systemic amyloidosis in inflammatory bowel disease: retrospective study on its prevalence, clinical presentation, and outcome. J Crohns Colitis 2010; 4 (3): 269–274. doi: 10.1016/j.crohns.2009.11. 009.
5. Basturk T, Ozagari A, Ozturk T et al. Crohn’s disease and secondary amyloidosis: early complication? A case report and review of the literature. J Ren Care 2009; 35 (3): 147–150. doi: 10.1111/j.1755-6686.2009.00106.x.
6. Lukáš M, Bortlík M, Pospíšilová P et al. Nefrotoxicita mesalazinu při dlouhodobé léčbě ulcerózní kolitidy a Crohnovy nemoci. Čes a Slov Gastroent 1999; 53 (5): 135–139.
7. Oikonomou KA, Kapsoritakis AN, Stefanidis I et al. Drug-induced nephrotoxicity in inflammatory bowel disease. Nephron Clin Pract 2011; 119 (2): 89–94. doi: 10.1159/000326682.
8. Teplan V, Ševela K. Toxické a lékové poškození jater a ledvin. Gastroent Hepatol 2019; 73 (1): 66–74. doi: 10.14735/amgh201966.
9. Pohjonen J, Nurmi R, Metso M et al. Inflammatory bowel disease in patients undergoing renal biopsies. Clin Kidney J 2019; 12 (5): 645–651. doi: 10.1093/ckj/sfz004.
10. Hubert D, Beaufils M, Meyrier A. Immunoglobulin A glomerular nephropathy associated with inflammatory colitis. Apropos of 2 cases. Presse Med 1984; 13 (17): 1083–1085.
11. Makdassy R, Beaufils M, Meyrier A et al. Pathologic conditions associated with IgA mesangial nephropathy: preliminary results. Contrib Nephrol 1984; 40: 292–295. doi: 10.1159/000409764
12. Takemura T, Okada M, Yagie K et al. An adolescent with IgA nephropathy and Crohn’s disease: pathogenetic implications. Pediatric Nephrol 2002; 17 (10): 863–866. doi: 10.1007/s00467-002-0943-x.
13. Tada Y, Ishihara S, Ito T et al. Successful use of maintenance infliximab for nephropathy in patients with secondary amyloidosis complicating Crohn’s disease. Intern Med 2013; 52 (17): 1899–1902. doi: 10.2169/internalmedicine.52.0340.
14. Chiba M, Tsuda S, Tsuji T et al. Crohn’s disease successfully treated with infliximab in a patient receiving hemodialysis: case report and review of the literature. Medicine (Baltimore) 2014; 93 (7): e54. doi: 10.1097/MD.0000000000000 054.
15. Webb TN, Griffiths H, Miyashita Y et al. Atypical hemolytic uremic syndrome and chronic ulcerative colitis treated with eculizumab. Int J Med Pharm Case Reports 2015; 4 (5): 105–112. doi: 10.9734/IJMPCR/2015/18771.
16. Schnitzler F, Friedrich M, Stallhofer J et al. Solid organ transplantation in patients with inflammatory bowel disease (IBD): analysis of transplantation outcome and IBD activity in a large single center cohort. PLoS One 2015; 10 (8): e0135807. doi: 10.1371/journal.pone.0135807.
17. Pittman ME, Jessurun J, Yantiss RK. Differentiating posttransplant inflammatory bowel disease and other colitides in renal transplant patients. Am J Surg Pathol 2017; 41 (12): 1666–1674. doi: 10.1097/PAS.0000000000000921.
18. Primas C, Novacek G, Schweiger K et al. Renal insufficiency in IBD – prevalence and possible pathogenetic aspects. J Crohn’s Colitis 2013; 7 (12): 630–634. doi: 10.1016/ j.crohns.2013.05.001.

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