IgA nephropathy and thin basement membrane disease in association with Crohn disease

Abstract

There have been a wide variety of reported renal parenchymal diseases associated with inflammatory bowel disease, ranging from interstitial nephritis to amyloidosis to immune complex glomerulonephritis. Two pediatric cases of renal parenchymal pathology in association with Crohn disease are presented. The first is an 11-year-old child who presented with recurrent bouts of gross hematuria, biopsy-proven IgA nephropathy, and later developed Crohn disease 4 years after the initial presentation. Her renal function is normal with persistent isolated microscopic hematuria. The second case is that of a 9-year-old male who presented with the classic gastrointestinal manifestations of Crohn disease, later developed hematuria and proteinuria, and was found on a renal biopsy to have thin basement membrane disease. There have been several reported cases of IgA nephropathy associated with inflammatory bowel disease; but to our knowledge, this is the first case of thin basement membrane disease occurring in conjunction with Crohn disease. Discussion focuses on the relationship of IgA nephropathy with inflammatory bowel disease with additional comments on thin basement membrane disease.

The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease

“…They described both clinical and pathologic remission of kidney disease concomitant with the treatment of symptoms of intestinal disease. Nineteen subsequent case reports in the literature have described IgAN in IBD (9,22,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). A majority of these patients had IgAN during onset or exacerbation of IBD, as well as clinical remission of kidney disease in conjunction with successful treatment of bowel inflammation.…”

IgA nephropathy in association with Crohn's disease: a case report and brief review of the literature

“…Various histological forms of glomerulonephritis associated with Crohn's disease are described, including four cases of membranoproliferative glomerulonephritis, 10-13 one case of mesangial proliferative glomerulonephritis, 14 two cases of membranous nephropathy, 15,16 one case of thin basement membrane disease, 17 one case of IgA antiglomerular basement membrane disease, 6 and nine cases of IgAN. [17][18][19][20][21][22][23][24][25] Renal manifestations occurred in the setting of active bowel disease in every case. Furthermore, it is of particular interest that proteinuria and renal function often improved in parallel under the treatment of the gastrointestinal disorder, suggesting a glomerulonephritis secondary to the inflammatory bowel disease, though a direct effect of the steroid treatment per se cannot be excluded.…”

“…17,22,23 The first report was published in 1984 by Hubert et al and involved two patients: one with ulcerative colitis and the other with Crohn's disease, who developed glomerulonephritis due to IgA mesangial deposits. 18 The age distribution in the reported cases is similar to that of patients with Crohn's disease without glomerulonephritis with a median of 22 years (range 10-36 years).…”

IgA Glycosylation and IgA Immune Complexes in the Pathogenesis of IgA Nephropathy

“…Glomerular sclerosis and interstitial fibrosis generally signify more serious disease and are frequently associated with progressive disease that leads to end-stage renal failure in 20-40% patients within 20 years of diagnosis (4)(5)(6). Hematuria is typical and often includes episodes of macroscopic bleeding that coincide with mucosal infections, including those of upper respiratory tract and digestive system (4,(7)(8)(9).…”