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Abstract: PO2408

The Spectrum of Kidney Disease and Outcomes in US Veterans with Inflammatory Bowel Disease

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Ravipati, Prasanth, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Reule, Scott, VISN 23 VA Midwest Health Care Network, Eagan, Minnesota, United States
  • Bren, Alyssa, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Bu, Lihong, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Nachman, Patrick H., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background

Glomerular and tubulointerstitial diseases have been associated with inflammatory bowel disease (ulcerative colitis, UC and Crohn’s disease, CD). However, the clinical outcomes of UC and CD patients who underwent kidney biopsy are not well described. We present a case series of the kidney biopsy findings and clinical outcomes of veterans with UC and CD from the US department of Veteran’s Affairs (VA) health system.

Methods

We performed a retrospective review of the VA electronic health record. Patients were included if they had UC or CD diagnosed by gastroenterology evaluation and biopsy. Kidney biopsy data including primary and secondary diagnoses, degree of interstitial fibrosis and tubular atrophy (IFTA), and degree of arteriosclerosis were extracted from biopsy reports. Incident end-stage kidney disease (ESKD) was defined as requirement of renal replacement therapy. All analyses were performed using SAS.

Results

Of 59,007 patients with an ICD code of inflammatory bowel disease, 66 patients had kidney tumor biopsies and 140 patients (91 with UC and 49 with CD) underwent biopsy to evaluate intrinsic kidney disease. At the time of kidney biopsy, the mean serum creatinine was 2.9 mg/dL for UC and 3.4 mg/dL for CD and the mean urine protein to creatinine ratio was 3.8 g/g for UC and 3.0 g/g for CD. The 5 most common primary diagnoses were IgA nephropathy (16%), diabetic nephropathy (14%), acute interstitial nephritis (12%), FSGS (8%), and membranous glomerulopathy (6%). Additionally, 13% of patients had interstitial nephritis (acute or chronic) as a secondary diagnosis. Moderate or severe IFTA was seen in 45% of biopsies. 24 UC patients (26%) and 10 CD patients (20%) progressed to ESKD, with a mean time from kidney biopsy of 3.1 and 1.9 years, respectively. 41 UC patients (45%) and 17 CD patients (34%) died, with a mean time from kidney biopsy of 4.3 and 4.6 years, respectively.

Conclusion

Among US Veterans with UC or CD who underwent kidney biopsy, the most common findings were: IgA nephropathy, interstitial nephritis, and diabetic nephropathy. Patients had advanced kidney disease at biopsy, and subsequent ESKD or death were common within a relatively short time period. These findings suggest a delay in diagnosis and possibly a low rate of diagnosis. Greater provider awareness may lead to earlier detection and improve outcomes.