Abstract
As extra-intestinal manifestations (EIMs) are frequent in inflammatory bowel disease (IBD) and affect morbidity and sometimes even mortality, vigilance in the surveillance of EIMs and installing the appropriate treatment are essential. Data on renal manifestations in patients with IBD are however rare. Nevertheless, up to 5–15% of adult patients with IBD will develop chronic kidney disease over time. The pathophysiology of renal involvement in patients with IBD is complex and poorly understood, with a wide range of renal disorders affecting the glomeruli and/or the tubular structure. Furthermore, medication used to treat IBD can be potentially nephrotoxic and metabolic complication due to the disease itself can furthermore cause renal damage. The aim of this systematic review is to provide an overview of the existing data in literature on these renal manifestations and complications in patients with IBD.
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Abbreviations
- AKI:
-
Acute kidney injury
- 5-ASA:
-
5-Aminosalicylic acid
- CAKUT:
-
Congenital abnormalities of the kidney and urinary tract
- CD:
-
Crohn’s disease
- CKD:
-
Chronic kidney disease
- eGFR:
-
Estimated glomerular filtration rate
- EIM:
-
Extra-intestinal manifestations
- ESRD:
-
End-stage renal disease
- HLA:
-
Human leukocyte antigen
- IBD:
-
Inflammatory bowel disease
- TNF-α:
-
Tumor necrosis factor alpha
- UC:
-
Ulcerative colitis
References
Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13:144–64.
Harbord M, Annese V, Vavricka SR, et al. The first european evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10:239–54.
Jose FA, Garnett EA, Vittinghoff E, et al. Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:63–8.
Greuter T, Bertoldo F, Rechner R, et al. Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment. J Pediatr Gastroenterol Nutr. 2017;65:200–6.
Guariso G, Gasparetto M, Visonà Dalla Pozza L, et al. Inflammatory bowel disease developing in paediatric and adult age. J Pediatr Gastroenterol Nutr. 2010;51:698–707.
Vavricka SR, Brun L, Ballabeni P, et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol. 2011;106:110–9.
Monsén U, Sorstad J, Hellers G, et al. Extracolonic diagnoses in ulcerative colitis: an epidemiological study. Am J Gastroenterol. 1990;85:711–6.
Hedin CRH, Vavricka SR, Stagg AJ, et al. The pathogenesis of extraintestinal manifestations: implications for IBD research, diagnosis, and therapy. J Crohns Colitis. 2019;13:541–54.
van Sommeren S, Janse M, Karjalainen J, et al. Extraintestinal manifestations and complications in inflammatory bowel disease: from shared genetics to shared biological pathways. Inflamm Bowel Dis. 2014;20:987–94.
Greuter T, Vavricka SR. Extraintestinal manifestations in inflammatory bowel disease - epidemiology, genetics, and pathogenesis. Expert Rev Gastroenterol Hepatol. 2019;13:307–17.
Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2011;7:235–41.
Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol. 2006;12:4819–31.
Ott C, Schölmerich J. Extraintestinal manifestations and complications in IBD. Nat Rev Gastroenterol Hepatol. 2013;10:585–95.
Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012;72:2333–49.
Mutalib M. Renal involvement in paediatric inflammatory bowel disease. Pediatr Nephrol. 2021;36:279–85.
Torricelli FC, Reichard C, Monga M. Urolithiasis in complicated inflammatory bowel disease: a comprehensive analysis of urine profile and stone composition. Int Urol Nephrol. 2021;53:205–9.
Pardi DS, Tremaine WJ, Sandborn WJ, et al. Renal and urologic complications of inflammatory bowel disease. Am J Gastroenterol. 1998;93:504–14.
Bianchi L, Gaiani F, Bizzarri B, et al. Renal lithiasis and inflammatory bowel diseases, an update on pediatric population. Acta Biomed. 2018;89:76–80.
Cury DB, Moss AC, Schor N. Nephrolithiasis in patients with inflammatory bowel disease in the community. Int J Nephrol Renovasc Dis. 2013;6:139–42.
Stark CM, Gorman GH, Nylund CM. Association of inflammatory bowel disease and urolithiasis in hospitalized pediatric patients. Inflamm Bowel Dis. 2017;23:1777–82.
Dimke H, Winther-Jensen M, Allin KH, et al. Risk of urolithiasis in patients with inflammatory bowel disease: a nationwide danish cohort study 1977–2018. Clin Gastroenterol Hepatol. 2021;19:2532-40.e2.
Ganji-Arjenaki M, Nasri H, Rafieian-Kopaei M. Nephrolithiasis as a common urinary system manifestation of inflammatory bowel diseases; a clinical review and meta-analysis. J Nephropathol. 2017;6:264–9.
Ambruzs JM, Larsen CP. Renal manifestations of inflammatory bowel disease. Rheum Dis Clin North Am. 2018;44:699–714.
Buchman AL, Moukarzel AA, Ament ME. Excessive urinary oxalate excretion occurs in long-term TPN patients both with and without ileostomies. J Am Coll Nutr. 1995;14:24–8.
Oikonomou K, Kapsoritakis A, Eleftheriadis T, et al. Renal manifestations and complications of inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1034–45.
Corica D, Romano C. Renal involvement in inflammatory bowel diseases. J Crohns Colitis. 2016;10:226–35.
Kumar R, Ghoshal UC, Singh G, et al. Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel disease: possible role in renal stone formation. J Gastroenterol Hepatol. 2004;19:1403–9.
Hueppelshaeuser R, von Unruh GE, Habbig S, et al. Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease. Pediatr Nephrol. 2012;27:1103–9.
Arora Z, Mukewar S, Lopez R, et al. Etiopathogenesis of nephrolithiasis in ulcerative colitis patients with the ileal pouch anal anastomosis. Inflamm Bowel Dis. 2017;23:840–6.
Clark JH, Fitzgerald JF, Bergstein JM. Nephrolithiasis in childhood inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1985;4:829–34.
McConnell N, Campbell S, Gillanders I, et al. Risk factors for developing renal stones in inflammatory bowel disease. BJU Int. 2002;89:835–41.
Caudarella R, Rizzoli E, Pironi L, et al. Renal stone formation in patients with inflammatory bowel disease. Scanning Microsc. 1993;7:371–9.
Worcester EM. Stones from bowel disease. Endocrinol Metab Clin North Am. 2002;31:979–99.
Oikonomou KA, Kapsoritakis AN, Stefanidis I, et al. Drug-induced nephrotoxicity in inflammatory bowel disease. Nephron Clin Pract. 2011;119:c89-94.
Bennett WM, DeMattos A, Meyer MM, et al. Chronic cyclosporine nephropathy: the Achilles’ heel of immunosuppressive therapy. Kidney Int. 1996;50:1089–100.
Hosoi K, Arai K, Matsuoka K, et al. Prolonged tacrolimus for pediatric gastrointestinal disorder: Double-edged sword? Pediatr Int. 2017;59:588–92.
Corrigan G, Stevens PE. Review article: interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease. Aliment Pharmacol Ther. 2000;14:1–6.
Schreiber S, Hämling J, Zehnter E, et al. Renal tubular dysfunction in patients with inflammatory bowel disease treated with aminosalicylate. Gut. 1997;40:761–6.
Patel H, Barr A, Jeejeebhoy KN. Renal effects of long-term treatment with 5-aminosalicylic acid. Can J Gastroenterol. 2009;23:170–6.
Calder IC, Funder CC, Green CR, et al. Nephrotoxic lesions from 5-aminosalicylic Acid. Br Med J. 1972;1:152–4.
Bilyard KG, Joseph EC, Metcalf R. Mesalazine: an overview of key preclinical studies. Scand J Gastroenterol Suppl. 1990;172:52–5.
Van Staa TP, Travis S, Leufkens HG, et al. 5-aminosalicylic acids and the risk of renal disease: a large British epidemiologic study. Gastroenterology. 2004;126:1733–9.
Gisbert JP, González-Lama Y, Maté J. 5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2007;13:629–38.
Sehgal P, Colombel JF, Aboubakr A, et al. Systematic review: safety of mesalazine in ulcerative colitis. Aliment Pharmacol Ther. 2018;47:1597–609.
Heap GA, So K, Weedon M, et al. Clinical Features and HLA Association of 5-Aminosalicylate (5-ASA)-induced Nephrotoxicity in Inflammatory Bowel Disease. J Crohns Colitis. 2016;10:149–58.
de Jong DJ, Tielen J, Habraken CM, et al. 5-Aminosalicylates and effects on renal function in patients with Crohn’s disease. Inflamm Bowel Dis. 2005;11:972–6.
Jairath V, Hokkanen SRK, Guizzetti L, et al. No increased risk of nephrotoxicity associated with 5-aminosalicylic acid in IBD: a population-based cohort and nested case-control study. Aliment Pharmacol Ther. 2019;50:416–24.
Ransford RA, Langman MJ. Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut. 2002;51:536–9.
Elseviers MM, D’Haens G, Lerebours E, et al. Renal impairment in patients with inflammatory bowel disease: association with aminosalicylate therapy? Clin Nephrol. 2004;61:83–9.
Bir K, Herzenberg AM, Carette S. Azathioprine induced acute interstitial nephritis as the cause of rapidly progressive renal failure in a patient with Wegener’s granulomatosis. J Rheumatol. 2006;33:185–7.
Meys E, Devogelaer JP, Geubel A, et al. Fever, hepatitis and acute interstitial nephritis in a patient with rheumatoid arthritis. Concurrent manifestations of azathioprine hypersensitivity. J Rheumatol. 1992;19:807–9.
Stanton B, Caza T, Huang D, et al. Tubulointerstitial nephritis as the initial presentation of crohn’s disease and successful treatment with infliximab. ACG Case Rep J. 2017;4: e24.
Neale TJ, Rüger BM, Macaulay H, et al. Tumor necrosis factor-alpha is expressed by glomerular visceral epithelial cells in human membranous nephropathy. Am J Pathol. 1995;146:1444–54.
Charles PJ, Smeenk RJ, De Jong J, et al. Assessment of antibodies to double-stranded DNA induced in rheumatoid arthritis patients following treatment with infliximab, a monoclonal antibody to tumor necrosis factor alpha: findings in open-label and randomized placebo-controlled trials. Arthritis Rheum. 2000;43:2383–90.
Williams VL, Cohen PR. TNF alpha antagonist-induced lupus-like syndrome: report and review of the literature with implications for treatment with alternative TNF alpha antagonists. Int J Dermatol. 2011;50:619–25.
Pastore S, Naviglio S, Canuto A, et al. Serious adverse events associated with anti-tumor necrosis factor alpha agents in pediatric-onset inflammatory bowel disease and juvenile idiopathic arthritis in a real-life setting. Paediatr Drugs. 2018;20:165–71.
Becher B, Blain M, Giacomini PS, et al. Inhibition of Th1 polarization by soluble TNF receptor is dependent on antigen-presenting cell-derived IL-12. J Immunol. 1999;162:684–8.
Prinz JC. Autoimmune-like syndromes during TNF blockade: does infection have a role? Nat Rev Rheumatol. 2011;7:429–34.
Bailly E, Von Tokarski F, Beau-Salinas F, et al. Interstitial nephritis secondary to vedolizumab treatment in crohn disease and safe rechallenge using steroids: a case report. Am J Kidney Dis. 2018;71:142–5.
Vegh Z, Macsai E, Lakatos L, et al. The incidence of glomerulonephritis in a population-based inception cohort of patients with inflammatory bowel disease. Dig Liver Dis. 2017;49:718–9.
Jang HM, Baek HS, Kim JE, et al. Renal involvement in children and adolescents with inflammatory bowel disease. Korean J Pediatr. 2018;61:327–31.
Elaziz MMA, Fayed A. Patterns of renal involvement in a cohort of patients with inflammatory bowel disease in Egypt. Acta Gastroenterol Belg. 2018;81:381–5.
Velciov S, Gluhovschi G, Sporea I, et al. Asymptomatic urinary anomalies, hematuria and proteinuria, in patients with inflammatory bowel disease. Preliminary study. Rom J Intern Med. 2011;49:113–20.
Fraser JS, Muller AF, Smith DJ, et al. Renal tubular injury is present in acute inflammatory bowel disease prior to the introduction of drug therapy. Aliment Pharmacol Ther. 2001;15:1131–7.
Kreisel W, Wolf LM, Grotz W, et al. Renal tubular damage: an extraintestinal manifestation of chronic inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1996;8:461–8.
Herrlinger KR, Noftz MK, Fellermann K, et al. Minimal renal dysfunction in inflammatory bowel disease is related to disease activity but not to 5-ASA use. Aliment Pharmacol Ther. 2001;15:363–9.
Ambruzs JM, Walker PD, Larsen CP. The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. Clin J Am Soc Nephrol. 2014;9:265–70.
Zhao L, Ren G, Fan R, et al. Spectrum and prognosis of renal histopathological lesions in patients with inflammatory bowel disease: a cross-sectional study from a single center in China. Clin Exp Med. 2021. https://doi.org/10.1007/s10238-021-00766-0.
Joher N, Gosset C, Guerrot D, et al. IgA nephropathy in association with inflammatory bowel diseases: results from a national study and systematic literature review. Nephrol Dial Transplant. 2021:gfaa378.
Kiryluk K, Li Y, Scolari F, et al. Discovery of new risk loci for IgA nephropathy implicates genes involved in immunity against intestinal pathogens. Nat Genet. 2014;46:1187–96.
Shi D, Zhong Z, Wang M, et al. Identification of susceptibility locus shared by IgA nephropathy and inflammatory bowel disease in a Chinese Han population. J Hum Genet. 2020;65:241–9.
Toyoda H, Wang SJ, Yang HY, et al. Distinct associations of HLA class II genes with inflammatory bowel disease. Gastroenterology. 1993;104:741–8.
Freedman BI, Spray BJ, Heise ER. HLA associations in IgA nephropathy and focal and segmental glomerulosclerosis. Am J Kidney Dis. 1994;23:352–7.
Suárez-Fueyo A, Bradley SJ, Klatzmann D, et al. T cells and autoimmune kidney disease. Nat Rev Nephrol. 2017;13:329–43.
Coppo R. The pathogenetic potential of environmental antigens in IgA nephropathy. Am J Kidney Dis. 1988;12:420–4.
Oliveira DB. Membranous nephropathy: an IgG4-mediated disease. Lancet. 1998;351:670–1.
Wang J, Anders RA, Wu Q, et al. Dysregulated LIGHT expression on T cells mediates intestinal inflammation and contributes to IgA nephropathy. Clin Invest. 2004;113:826–35.
Sattianayagam PT, Gillmore JD, Pinney JH, et al. Inflammatory bowel disease and systemic AA amyloidosis. Dig Dis Sci. 2013;58:1689–97.
Tosca Cuquerella J, Bosca-Watts MM, Anton Ausejo R, et al. Amyloidosis in inflammatory bowel disease: a systematic review of epidemiology, clinical features, and treatment. J Crohns Colitis. 2016;10:1245–53.
Sharma P, Aguilar R, Siddiqui OA, et al. Secondary systemic amyloidosis in inflammatory bowel disease: a nationwide analysis. Ann Gastroenterol. 2017;30:504–11.
Fausa O, Nygaard K, Elgjo K. Amyloidosis and Crohn’s disease. Scand J Gastroenterol. 1977;12:657–62.
Wester AL, Vatn MH, Fausa O. Secondary amyloidosis in inflammatory bowel disease: a study of 18 patients admitted to Rikshospitalet University Hospital, Oslo, from 1962 to 1998. Inflamm Bowel Dis. 2001;7:295–300.
Denis MA, Cosyns JP, Persu A, et al. Control of AA amyloidosis complicating Crohn’s disease: a clinico-pathological study. Eur J Clin Invest. 2013;43:292–301.
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;4:269–74.
Primas C, Novacek G, Schweiger K, et al. Renal insufficiency in IBD–prevalence and possible pathogenetic aspects. J Crohns Colitis. 2013;7:e630–4.
Lewis B, Mukewar S, Lopez R, et al. Frequency and risk factors of renal insufficiency in inflammatory bowel disease inpatients. Inflamm Bowel Dis. 2013;19:1846–51.
Vajravelu RK, Copelovitch L, Osterman MT, et al. Inflammatory bowel diseases are associated with an increased risk for chronic kidney disease, which decreases with age. Clin Gastroenterol Hepatol. 2020;18:2262–8.
Park S, Chun J, Han KD, et al. Increased end-stage renal disease risk in patients with inflammatory bowel disease: A nationwide population-based study. World J Gastroenterol. 2018;24:4798–808.
Lauritzen D, Andreassen BU, Heegaard NHH, et al. Pediatric inflammatory bowel diseases: should we be looking for kidney abnormalities? Inflamm Bowel Dis. 2018;24:2599–605.
Andrés-Jensen L, Jørgensen FS, Thorup J, et al. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child. 2016;101:819–24.
Wiesel A, Queisser-Luft A, Clementi M, et al. Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries. Eur J Med Genet. 2005;48:131–44.
Pohl M, Bhatnagar V, Mendoza SA, et al. Toward an etiological classification of developmental disorders of the kidney and upper urinary tract. Kidney Int. 2002;61:10–9.
Guillo L, D’Amico F, Achit H, et al. Kidney function monitoring to prevent 5-aminosalicylic acid nephrotoxicity: What the gastroenterologist should know. Dig Liver Dis. 2021;53:691–6.
Guillo L, Delanaye P, Flamant M, et al. Kidney function monitoring in inflammatory bowel disease: The MONITORED consensus. Dig Liver Dis. 2021;S1590–8658(21):00848–53.
Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379:165–80.
Kazancioğlu R. Risk factors for chronic kidney disease: an update. Kidney Int Suppl. 2011;2013(3):368–71.
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Study concept, literature search and data analysis, and manuscript writing was performed by Karen van Hoeve. Data interpretation and manuscript critical revision was performed by Ilse Hoffman. All authors approved the final version of the article, including the authorship list.
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Supplementary file2 (DOCX 55 KB) Online Resource 2. Clinical characteristics of IBD patients associated with glomerulonephritis or tubulointerstitial nephritis. Summarize of published case reports.
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van Hoeve, K., Hoffman, I. Renal manifestations in inflammatory bowel disease: a systematic review. J Gastroenterol 57, 619–629 (2022). https://doi.org/10.1007/s00535-022-01903-6
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DOI: https://doi.org/10.1007/s00535-022-01903-6