The pathological and outcome characteristics of renal lesions in Crohn’s disease

Abstract

Background The inflammatory bowel disease, containing Crohn’s disease and ulcerative colitis, was rare in the population, especially in the complication of kidney disease. A few studies had found proteinuria played a potential indicator of inflammatory bowel disease occurrence and activity. This study aimed to better define the histopathologic spectrum and study the outcome of renal disease in Crohn’s disease. Methods A retrospective study of 3557 Crohn's disease from January 1st, 2016 to July 1st, 2021 in the Sixth Affiliated Hospital of Sun Yat-sen University identified 20 (0.56% [20/3557]) patients who underwent kidney biopsy. All biopsy specimens were examined by standard procedures containing light microscopy, immunofluorescence, and electron microscopy. Results Twenty cases were shown in this review study. Subnephrotic proteinuria (30% [6 of 20]), persistent hematuria and proteinuria (25% [5 of 20]), and isolated hematuria with acanthocytes (25% [5 of 20]) were the main indications for kidney biopsy. The most common diagnosis was IgA nephropathy (70% [14/20]), followed by minimal change disease (10% [2/20]), acute interstitial nephritis (5% [1/20]), granulomatous interstitial nephritis (5% [1/20]), non-IgA mesangial proliferative nephritis (5% [1/20]) and thin basement membrane nephropathy (5% [1/20]). The Lee classification of IgA nephropathy was mostly II or III level. Glomerular mesangial hyperplasia was the most common pathologic manifestation according to the MEST-C Sore. After twelve-month treatment, the majority of patients turned to complete remission of renal disease by measuring proteinuria, while 3 patients still stayed in the relapse stage and 6 patients turned to partial remission by measuring hematuria. Conclusions IgA nephropathy is the most common kidney biopsy diagnosis in Crohn's disease. Renal damage in Crohn's disease mainly involves the glomerulus, especially the mesangial matrix. After the treatment, proteinuria might be in remission, but hematuria remains.

Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes

“…In addition, it should be noted that patients with IBD may experience AIN unrelated to 5-ASA, which poses a significant diagnostic challenge. 20 Interestingly, in our study up to two-thirds of patients had granulomatous interstitial kidney disease unrelated to 5-ASA exposure, supporting the idea that this histologic feature may represent a genuine EIM. 47 Another immunosuppressive agent that has been associated with the development of AIN and CIN is azathioprine, 48 , 49 although in our study, only a small subset of cases had received this treatment for IBD.…”

“…IgAN was the most frequent glomerular disease in our cohort, and this is consistent with previous studies. 15 , 18 , 19 , 20 Patients with IgAN had a significant kidney impairment at the time of diagnosis, along with a high disease chronicity in kidney biopsy. Although the association between IgAN and IBD may be coincidental, emerging evidence suggests a potential common underlying mechanism in disease pathogenesis.…”

Multiple Complications of Crohn’s Disease and the Need for Early and Continuous Multidisciplinary Undertaking

“…IgAN is not rare in the setting of Crohn's disease [5] and is relatively proportional to the extent of gastrointestinal (GI) inflammation, which promotes IgA1-producing cells, thereby leading to mesangial deposits of IgA [2,3,12].…”

“…Urinary lithiasis and associated complications are the most common urinary complications of Crohn's disease [2][3][4]. One of the most frequently encountered Crohn's-related renal lesions in kidney biopsies is immunoglobulin A nephropathy (IgAN), with a prevalence ranging from 16% to 70% depending on ethnicity [5].…”

Determining the link between psoriasis and Crohn's disease using bioinformatics and systems biology approaches

“…Reports in recent years indicate that the incidence of the disease is rapidly increasing 8 . The disease is a proliferative lesion 5 throughout all layers 9 of the bowel wall that can invade the mesentery 10 and the local lymph nodes 11 of the bowel and is characterized by immune-mediated chronic in ammation 12 . Despite extensive research, the de nitive pathogenic mechanisms are not fully understood 5,13 .…”