The kidneys in inflammatory bowel disease

Abstract

Extraintestinal manifestations and complications are common
in patients with inflammatory bowel disease (IBD) and
may involve almost any organ or system. Renal or urinary
complications occur in 4-23% of patients often in those with
severe long-standing disease. The most common manifestations
are kidney stones, enterovesical fistulas and ureteral
obstruction. Genital involvement is uncommon in IBD.
Patients with IBD have a risk of nephrolithiasis 10-100
times greater than that for the general hospital population.
Glomerulonephritis (GN) in IBD has been reported in at
least 27 patients; of these 7 had CD, 17 had UC and 3 were
indeterminate.Histology changes range from minimal
change nephropathy to rapidly progressive crescentic GN
which may be accompanied by active tubulointerstitial nephritis.
Tubulointerstitial abnormalities are not uncommon
in autopsy studies of IBD patients. Granulomatous
interstitial nephritis, interstitial nephritis with hyperoxalouria
and renal tubular acidosis have also been reported.
Inflammatory bowel disease is an uncommon cause of
secondary amyloidosis. Complications from medical therapy
are relatively rare in the majority of drugs used to treat
IBD. There is little or no nephrotoxicity with many drugs
used including corticosteroids, azathioprine or 6-mercaptopurine,
metronidazole and low dose methotrexate. The
drugs with significant potential renal toxicity are the aminosalicylates
(sulfasalazine, mesalamine, 5-ASA, olsalazine)
and cyclosporine. Surgical complications following bowel surgery include ureteral injury, urinary vetention and
sexual dysfunction.
Key words: renal, urinary, genital, drugs, therapy, inflammatory
bowel disease, Crohns, ulcerative colitis, glomerular,
tubular, interstitial, kidneys.