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Kidney Week

Abstract: TH-PO599

Kidney Disease Outcomes in Patients with Inflammatory Bowel Disease

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Saha, Manish K., University of North Carolina, Chapel Hill, North Carolina, United States
  • Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States
  • Laurin, Louis-Philippe, Universite de Montreal, Montreal, Quebec, Canada
  • Leclerc, Simon, Universite de Montreal, Montreal, Quebec, Canada
  • Falk, Ronald, University of North Carolina, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., University of North Carolina, Chapel Hill, North Carolina, United States
  • Mottl, Amy K., University of North Carolina, Chapel Hill, North Carolina, United States
  • Hu, Yichun, University of North Carolina, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., University of North Carolina, Chapel Hill, North Carolina, United States
Background

Patients with inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) may have extra-intestinal manifestations (EIM). The prevalence of histologic patterns of kidney disease seen in IBD patients is known, but clinical characteristics and long-term kidney outcomes remain ill-defined.

Methods

We performed a multi-center, retrospective, study of IBD patients who had a kidney biopsy across 3 centers. Inclusion criteria were: (i) IBD diagnosis based on clinical/histological characteristics and (ii) kidney biopsy with pathology report available. Baseline clinical data were analyzed for the whole cohort while outcomes were evaluated in those with available follow-up. Between groups, comparisons for continuous variables were made using Wilcoxon two-sample test and Fisher’s exact test for categorical values.

Results

The frequency of various glomerular (GN), tubulointerstitial (TIN), and vascular (VD) processes are listed in Table 1. Patients with VD were older compared to other groups. At presentation, proteinuria was higher in patients with GN compared to those with TIN [2.13 (0.84, 4.07) vs. 0.30 (0.25, 1.25) p<0.05] and kidney function was worse in those with TIN compared to GN (3.10 [1.98, 4.50] vs. 2.10 [1.20, 3.11], p=0.05]). TIN occurred in 3 treatment naïve patients. In median follow-up of >3 years, 6 of 35 (17%) GN patients, 1 of 8 (12.5%) TIN, and 2 of 4 (50%) VD patients developed ESKD.

Conclusion

Patients with IBD may have varying forms of CKD including GN, and routine monitoring of kidney function is essential for early diagnosis and treatment. TIN may occur as an EIM independent of sulfasalzine therapy. Future studies are required to understand plausible shared immunopathogenesis.

Table 1 Frequency of various kidney diseases in patients with IBD
 CD+UC+IBD@
n=96
CD
n=56
UC
n=36
IgAN
FSGS
Amyloidosis-MGRS
ANCA-vasculitis
Other GN
18
10
8
8
12
11
6
5
3
5
6
3
3
5
7
TIN1485
VD1284
Others963

@IBD - 4 patients had IBD without distinctive features of CD/UC -- 1 each had IgAN, FSGS,TIN, ATN 4 patients in CD and 1 in UC group had only ATN; MGRS=monoclonal gammopathy of renal significance, ANCA=Anti-neutrophil cytoplasmic antibody; Others: neoplasm, non-specific interstitial fibrosis