Background and objectives: Kidney disease as a complication of inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), has been the subject of case reports. However, no cases series examining IBD and kidney disease has been published to date. This study aimed to evaluate a large series of kidney biopsy specimens from patients with IBD to better define the spectrum and relative frequencies of IBD-associated kidney pathology. Design, setting, participants, & measurements: A retrospective review of native kidney biopsy specimens obtained from March 2001 to June 2012 identified 83 patients with IBD. Standard processing of all biopsy specimens included light microscopy, immunofluorescence, and electron microscopy. Results: There were 45 cases of CD and 38 cases of UC represented. The most common indication for kidney biopsy was acute or chronic kidney failure (63% [52 of 83]) and nephrotic-range proteinuria (16% [13 of 83]). IgA nephropathy was the most common diagnosis (24% [20 of 83]), followed by interstitial nephritis (19% [16 of 83]), arterionephrosclerosis (12% [10 of 83]), acute tubular injury (8% [7 of 83]), proliferative GN (7% [6 of 83]), and minimal-change disease (5% [4 of 83]). When compared, the frequency of IgA nephropathy in IBD was significantly higher than in all other native renal biopsy specimens from the same time period (24% [20 of 83] versus 8% [2734 of 33,630]; P<0.001). Of the 16 cases of interstitial nephritis, 9 (56%) had current or recent past exposure to aminosalicylates, including all cases of granulomatous interstitial nephritis. Conclusions: IBD is associated with a spectrum of kidney diseases most commonly affecting the glomerular and tubulointerstitial compartments. IgA nephropathy is the most frequent kidney biopsy diagnosis in IBD and has a significantly higher diagnostic prevalence compared with all non-IBD kidney biopsy specimens. This may reflect a common pathogenic mechanism. Although many cases of tubulointerstitial nephritis are related to aminosalicylate exposure, the possibility of a direct relationship with IBD cannot be ruled out.
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机译：背景与目的：肾脏疾病是包括克罗恩病（CD）和溃疡性结肠炎（UC）在内的炎症性肠病（IBD）的并发症。然而，迄今为止，尚未发表检查IBD和肾脏疾病的病例系列。这项研究旨在评估IBD患者的大量肾脏活检标本，以更好地确定IBD相关肾脏病理的频谱和相对频率。设计，设置，参与者和测量：2001年3月至2012年6月获得的天然肾脏活检标本的回顾性研究确定了83例IBD患者。所有活检标本的标准处理包括光学显微镜，免疫荧光和电子显微镜。结果：代表CD 45例，UC 38例。肾活检的最常见指征是急性或慢性肾衰竭（63％[83 of 52]）和肾病范围蛋白尿（16％[83 of 13]）。 IgA肾病是最常见的诊断（24％[83 of 20]），其次是间质性肾炎（19％[83 of 16]），动脉硬化（12％[83 of 10]），急性肾小管损伤（8％[7] 83例[83]中的7％），增生性GN（7％[83的6]）和微小变化疾病（5％[83的4]）。比较时，IBD中IgA肾病的发生率显着高于同期的所有其他天然肾脏活检标本（24％[20 of 83]对8％[2734 of 33,630]; P <0.001）。在16例间质性肾炎中，有9例（56％）当前或近期接触过氨基水杨酸酯，包括所有肉芽肿性间质性肾炎。结论：IBD与多种肾脏疾病有关，最常影响肾小球和肾小管间质区室。与所有非IBD肾活检标本相比，IgA肾病是IBD中最常见的肾活检诊断，其诊断患病率明显更高。这可能反映了常见的致病机制。尽管肾小管间质性肾炎的许多病例与氨基水杨酸酯的暴露有关，但不能排除与IBD直接相关的可能性。
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