Insights into renal and urological complications of inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.

Keywords: Inflammatory bowel disease; Glomerulonephritis; Amyloidosis; Extra-intestinal manifestations; Nephrotoxicity; chronic kidney disease

Core Tip: Renal manifestations have been described in 4%-23% of the patients with Inflammatory bowel disease, leading to significant morbidity and mortality. Glomerulonephritis, nephrolithiasis, amyloidosis, and tubulointerstitial nephritis are common with approximately 5%-15% of the patients developing chronic kidney disease. Serum markers such as creatinine levels, especially cystatin-c levels, should be used to monitor renal function, especially in patients receiving nephrotoxic medications such as aminosalicylates and TNF-α inhibitors.