Crohn’s disease associated with renal amyloidosis successfully treated with an elemental diet

Abstract

We report a case of Crohn's disease associated with nephrotic syndrome due to renal amyloidosis in a 21-year-old man in whom remission of both Crohn's disease and the nephrotic syndrome has been maintained with an elemental diet. The patient developed toxic megacolon and nephrotic syndrome due to renal amyloidosis. Intensive intravenous prednisolone therapy with total parenteral nutrition was dramatically effective in treating the toxic megacolon and inducing remission in Crohn's disease and afterward, remission of the nephrotic syndrome. Remission of both conditions has been maintained for more than 2 years with the elemental diet. To our knowledge, this is the first confirmed case of Crohn's disease complicated with renal amyloidosis in which only slight proteinuria (below 0.3 g/day) was shown with an elemental diet used for a long period.

Renal artery stenosis associated with Crohn disease

“…It may develop as a result of glomerular, tubulointerstitial, or other renal pathologies reported in association with Crohn disease [2][3][4][5][6][7][8]. Our patient showed neither signs of renal functional impairment, nor signs of active urinary sediment associated with glomerular or tubulointerstitial injury.…”

“…Renal involvement includes IgA nephropathy [2], thin membrane disease [2], tubulointerstitial nephritis [3], amyloidosis [4], nephrotic syndrome [5], renal tubular acidosis [6], ureteral obstruction [7], nephrocalcinosis and nephrolithiasis [8]. To our knowledge, renal artery stenosis has not been described previously in a patient with Crohn disease.…”

Secondary Amyloidosis in a Patient with Long Duration Crohnʼs Disease Treated with Infliximab

“…[3] It is believed that nephrotic syndrome can be reversed and renal failure prevented if inflammation is stopped. [11] The possibility of end-stage renal disease in the near future may potentially lead to a means of controlling an otherwise refractory Crohn's disease, with the immunosuppression inherent in renal transplantation. [12] …”

Efficacy of scheduled infliximab maintenance therapy on systemic amyloidosis associated with crohnʼs disease

“…2 Infliximab is a chimeric antitumor necrosis factor alpha (TNF-a) monoclonal antibody and is proven to induce clinical response and remission in CD patients with rapid onset of mucosal healing. Recent studies show the efficacy of infliximab on secondary amyloidosis associated with rheumatic inflammatory diseases.…”