Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes
Introduction: Kidney disease is a well-known extraintestinal manifestation (EIM) associated with inflammatory bowel disease (IBD), with a variety of underlying etiologies. However, little is known about the overall outcomes and predictors. Methods: This is a retrospective, observational cohort study...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-02-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024923015991 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849336236479610880 |
|---|---|
| author | Federico Yandian Fernando Caravaca-Fontán Loren P. Herrera Hernandez Maria José Soler Sanjeev Sethi Fernando C. Fervenza |
| author_facet | Federico Yandian Fernando Caravaca-Fontán Loren P. Herrera Hernandez Maria José Soler Sanjeev Sethi Fernando C. Fervenza |
| author_sort | Federico Yandian |
| collection | DOAJ |
| description | Introduction: Kidney disease is a well-known extraintestinal manifestation (EIM) associated with inflammatory bowel disease (IBD), with a variety of underlying etiologies. However, little is known about the overall outcomes and predictors. Methods: This is a retrospective, observational cohort study. Patients with IBD in whom a native kidney biopsy was performed at Mayo Clinic (Rochester, MN) between 1994 and 2022, were included. Demographic, clinical, and histologic characteristics of prognostic interest were collected. The main outcomes were kidney failure, disease remission, kidney function changes at last follow-up, and death. Results: From a total cohort of 318 patients, we selected a study group of 111 patients followed-up with at our institution (45 ulcerative colitis [UC] and 66 Crohn’s disease [CD]), with a mean age of 48 ± 17 years (40% females). IgA nephropathy (IgAN), chronic interstitial nephritis (CIN), and acute interstitial nephritis (AIN) were the most common diagnoses (22%, 19%, 13%, respectively). Median estimated glomerular filtration rate (eGFR) at presentation was 30 ml/min per 1.73 m2 (interquartile range [IQR]: 17–54) and urinary protein-to-creatinine ratio [UPCR] 0.8 g/g (0.3–3.4), without differences between IBD types. During a median follow-up of 59 months (12–109), 29 patients (26%) reached kidney failure. By multivariable analysis, the main predictors of kidney failure were age (hazard ratio [HR]: 1.04; P = 0.002), baseline eGFR (HR: 0.94; P = 0.003) and histologic chronicity score (HR: 4.01; P < 0.001). Therapeutic management varied according to underlying etiology. Global survival (kidney failure + death) was significantly better in patients who achieved complete or partial remission, or stabilization or improvement of kidney function. Conclusion: One-fourth of patients with IBD with kidney disease may reach kidney failure, and the main determinants of this outcome is age, baseline eGFR, and degree of chronicity in kidney biopsy. |
| format | Article |
| id | doaj-art-e46a6e6f41ce4481aee5e89ee7106a12 |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-e46a6e6f41ce4481aee5e89ee7106a122025-08-20T03:45:02ZengElsevierKidney International Reports2468-02492024-02-019238339410.1016/j.ekir.2023.11.011Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and OutcomesFederico Yandian0Fernando Caravaca-Fontán1Loren P. Herrera Hernandez2Maria José Soler3Sanjeev Sethi4Fernando C. Fervenza5Department of Nephrology, Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay; Federico Yandian, Department of Nephrology, Hospital de Clínicas “Dr. Manuel Quintela”, Avenida Italia s/n. 11600, Montevideo, Uruguay.Department of Nephrology, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain; Correspondence: Fernando Caravaca-Fontán, Department of Nephrology, Instituto de Investigación Hospital 12 de Octubre, Avda. De Córdoba s/n. 28041, Madrid, Spain.Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USADepartment of Nephrology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA; Fernando C. Fervenza, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, Minnesota 55901, USA.Introduction: Kidney disease is a well-known extraintestinal manifestation (EIM) associated with inflammatory bowel disease (IBD), with a variety of underlying etiologies. However, little is known about the overall outcomes and predictors. Methods: This is a retrospective, observational cohort study. Patients with IBD in whom a native kidney biopsy was performed at Mayo Clinic (Rochester, MN) between 1994 and 2022, were included. Demographic, clinical, and histologic characteristics of prognostic interest were collected. The main outcomes were kidney failure, disease remission, kidney function changes at last follow-up, and death. Results: From a total cohort of 318 patients, we selected a study group of 111 patients followed-up with at our institution (45 ulcerative colitis [UC] and 66 Crohn’s disease [CD]), with a mean age of 48 ± 17 years (40% females). IgA nephropathy (IgAN), chronic interstitial nephritis (CIN), and acute interstitial nephritis (AIN) were the most common diagnoses (22%, 19%, 13%, respectively). Median estimated glomerular filtration rate (eGFR) at presentation was 30 ml/min per 1.73 m2 (interquartile range [IQR]: 17–54) and urinary protein-to-creatinine ratio [UPCR] 0.8 g/g (0.3–3.4), without differences between IBD types. During a median follow-up of 59 months (12–109), 29 patients (26%) reached kidney failure. By multivariable analysis, the main predictors of kidney failure were age (hazard ratio [HR]: 1.04; P = 0.002), baseline eGFR (HR: 0.94; P = 0.003) and histologic chronicity score (HR: 4.01; P < 0.001). Therapeutic management varied according to underlying etiology. Global survival (kidney failure + death) was significantly better in patients who achieved complete or partial remission, or stabilization or improvement of kidney function. Conclusion: One-fourth of patients with IBD with kidney disease may reach kidney failure, and the main determinants of this outcome is age, baseline eGFR, and degree of chronicity in kidney biopsy.http://www.sciencedirect.com/science/article/pii/S2468024923015991IgA nephropathyinflammatory bowel diseaseinterstitial nephritiskidney failuretotal chronicity score |
| spellingShingle | Federico Yandian Fernando Caravaca-Fontán Loren P. Herrera Hernandez Maria José Soler Sanjeev Sethi Fernando C. Fervenza Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes Kidney International Reports IgA nephropathy inflammatory bowel disease interstitial nephritis kidney failure total chronicity score |
| title | Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes |
| title_full | Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes |
| title_fullStr | Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes |
| title_full_unstemmed | Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes |
| title_short | Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes |
| title_sort | kidney diseases associated with inflammatory bowel disease impact of chronic histologic damage treatments and outcomes |
| topic | IgA nephropathy inflammatory bowel disease interstitial nephritis kidney failure total chronicity score |
| url | http://www.sciencedirect.com/science/article/pii/S2468024923015991 |
| work_keys_str_mv | AT federicoyandian kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes AT fernandocaravacafontan kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes AT lorenpherrerahernandez kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes AT mariajosesoler kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes AT sanjeevsethi kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes AT fernandocfervenza kidneydiseasesassociatedwithinflammatoryboweldiseaseimpactofchronichistologicdamagetreatmentsandoutcomes |