Abstract: SA-PO0902
Anti-Tumor Necrosis Factor-Associated IgAN
Session Information
- Glomerular Case Reports: ANCA, IgA, IgG, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ali, Sundus, University Hospitals, Cleveland, Ohio, United States
- Nasir, Ali Bin, Combined Military Hospital Malir, Karachi, Sindh, Pakistan
- Baban, Yaqot, MetroHealth Medical Center, Cleveland, Ohio, United States
- Savvides, Christopher, University Hospitals, Cleveland, Ohio, United States
Introduction
Tumor Necrosis Factor-alpha (TNF-alpha) inhibitors like Adalimumab have transformed the management of Crohn's disease and offer substantial clinical benefits. However, despite their effectiveness, TNF-alpha inhibitors are associated with IgA Nephropathy. This presents a challenge for clinicians, who must weigh the benefits of TNF-alpha inhibition against potential renal risks when treating patients with Crohn's disease.
Case Description
A 36-year-old with Crohn’s disease and CKD 3b A3 presented with intermittent low back pain and red urine, worsening after exercise. On Humira since 2017, switched to Hyrimoz in 2024, with no Crohn’s flares since 2017. Creatinine rose from 0.9 (12/2022) to 2.4 (1/2025). Anemic (Hb 10 g/dL) with worsening microscopic hematuria and new proteinuria (2g/g, improved to 1.3g/g with Lisinopril). Imaging showed no stones. Biopsy confirmed IgA nephropathy with strong mesangial IgA and C3 staining.
Discussion
Our case highlights the importance of using TNF-Alpha inhibitors such as Adalimumab with caution in patients with already existing glomerular disease or end stage renal disease. Although there have been cases of IgA Nephropathy in patients treated with Adalimumab for Plague Psoriasis after 18 months of treatment and Ankylosing Spondylitis after 04 years of treatment as well as in a patient with rheumatoid arthritis it has yet to be documented in patients being treated with Adalimumab for Crohn's disease. Even when Adalimumab is associated with Crohn's disease it is in the Pediatric Population in a 11 year old child whereas our patient is 36 years old and in a different demographic population. Unlike our case, another TNF alpha inhibitor Infliximab, has been reported to cause IgA Nephropathy when used for the treatment of Crohn's Disease. Infliximab has also been known to cause IgA Nephropathy in patient with Pustular Psoriasis as well as Ankylosing Spondylitis. It is important for a patient treated with Adalimumab for Crohn's Disease to have frequent follow ups with their renal function tests to monitor for TNF alpha inhibitor induced renal dysfunction, early diagnosis and treatment of which can be life saving.