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Active flare of IgA nephropathy during long-term therapy with anti-tumor necrosis factor-α antibody drugs for Crohn’s disease: three case reports and literature review

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Abstract

In recent years, increasing numbers of reports have described new onset or active disease flare of IgA nephropathy (IgAN) during administration of TNF-α inhibitor (TNFi) therapy for chronic inflammatory diseases. Crohn’s disease (CD) is the most common indication for TNFi therapy in this clinical setting, but the underlying etiology of IgAN in such patients remains unclear. We report our experience with three patients who developed acute worsening of preexisting urinalysis abnormalities and kidney dysfunction approximately 2 to 6 years after TNFi administration for CD. Kidney biopsies at the time of kidney disease flare revealed IgAN in two patients and IgAN complicated by acute tubulointerstitial nephritis in one patient. The CD and IgAN in all three patients were successfully managed with additional corticosteroid therapy and tonsillectomy without discontinuing TNFi therapy. The clinical course of our patients and similar patients described in the literature suggests that TNFi therapy for CD is associated with a relatively high risk for new onset or disease flare of IgAN. This report discusses the possible involvement of Th1/Th2 imbalance on the immunological background of CD or IgAN.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan

    Akihiro Shimizu, Kotaro Haruhara, Izumi Shirai, Kyohei Ogawa, Akane Miura, Kentaro Oshiro & Masato Ikeda

  2. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Nobuo Tsuboi, Hiroyuki Ueda & Takashi Yokoo

  3. Division of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan

    Shinya Yokote & Takaya Sasaki

  4. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Daisan Hospital, Tokyo, Japan

    Masahiro Okabe

Authors
  1. Akihiro Shimizu
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  2. Nobuo Tsuboi
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  4. Izumi Shirai
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Correspondence to Akihiro Shimizu.

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Shimizu, A., Tsuboi, N., Haruhara, K. et al. Active flare of IgA nephropathy during long-term therapy with anti-tumor necrosis factor-α antibody drugs for Crohn’s disease: three case reports and literature review. CEN Case Rep (2023). https://doi.org/10.1007/s13730-023-00836-0

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  • DOI: https://doi.org/10.1007/s13730-023-00836-0

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