Abstract
Background A 12-year-old boy presented to hospital with a 6-month history of crampy pre-defecation abdominal pain, non-bloody diarrhea, anorexia and weight loss. Investigations revealed hypochromic microcytic anemia, a low serum iron level, a low serum ferritin level and an elevated serum creatinine level. Histopathological examination of tissue specimens obtained at esophagogastroduodenoscopy and colonoscopy revealed features of Crohn's disease, and a renal biopsy demonstrated tubulointerstitial nephritis. A second case of tubulointerstitial nephritis in a patient with Crohn's disease, is also presented.
Investigations Physical examination, laboratory tests including full blood count, electrolytes, renal function, serum albumin, urinalysis and 24 h urinary protein, esophagogastroduodenoscopy, colonoscopy, abdominal ultrasonography, dimercaptosuccinic acid scan, renal diethylene triamine pentaacetic acid clearance study and renal biopsy.
Diagnosis Tubulointerstitial nephritis secondary to Crohn's disease.
Management Prednisone therapy (60 mg/day) for 1 month followed by a tapering schedule over 3 months.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Riis L et al. (2007) The prevalence of genetic and serologic markers in an unselected European population-based cohort of IBD patients. Inflamm Bowel Dis 13: 24–32
Marcus SB et al. (2008) Tubulointerstitial nephritis: an extraintestinal manifestation of Crohn disease in children. J Pediatr Gastroenterol Nutr 46: 338–341
Pardi DS et al. (1998) Renal and urologic complications of inflammatory bowel disease. Am J Gastroenterol 93: 504–514
Lino M et al. (2005) Tubulointerstitial nephritis and Fanconi syndrome in primary biliary cirrhosis. Am J Kidney Dis 46: e41–e46
Hu DC et al. (2004) Polymorphoneutrophilic infiltration in acute interstitial nephritis of Sjögren syndrome. Am J Med Sci 327: 278–280
Takeda S et al. (2004) IgG4-associated idiopathic tubulointerstitial nephritis complicating autoimmune pancreatitis. Nephrol Dial Transplant 19: 474–476
Omokawa A et al. (2008) Predominant tubulointerstitial nephritis in a patient with systemic lupus erythematosus: phenotype of infiltrating cells. Clin Nephrol 69: 436–444
Das KM (1999) Relationship of extraintestinal involvements in inflammatory bowel disease: new insights into autoimmune pathogenesis. Dig Dis Sci 44: 1–13
Arend LJ and Springate JE (2004) Interstitial nephritis from mesalazine: case report and literature review. Pediatr Nephrol 19: 550–553
Izzedine H et al. (2002) Primary chronic interstitial nephritis in Crohn's disease. Gastroenterology 123: 1436–1440
Archimandritis AJ and Weetch MS (1993) Kidney granuloma in Crohn's disease. BMJ 307: 540–541
Tovbin D et al. (2000) Severe interstitial nephritis in a patient with renal amyloidosis and exacerbation of Crohn's disease. Clin Nephrol 53: 147–151
Gisbert JP et al. (2007) 5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis 13: 629–638
Larchet M et al. (1988) Crohn's enteritis and chronic tubulo-interstitial nephropathy in an adolescent [French]. Arch Fr Pediatr 45: 649–651
Benador N et al. (2000) Interstitial nephritis in children with Crohn's disease. Clin Pediatr (Phila) 39: 253–254
Behrens R and Ruder H (1992) Chronic inflammatory intestinal disease and nephritis [German]. Klin Padiatr 204: 61–64
Witte T et al. (1994) Interstitial nephritis associated with 5-aminosalicylic acid. Nephron 67: 481–482
Wilcox GM et al. (1996) Nephrotoxicity associated with olsalazine. Am J Med 100: 238–240
World MJ et al. (1996) Mesalazine-associated interstitial nephritis. Nephrol Dial Transplant 11: 614–621
Hamling J et al. (1997) 5-Aminosalicylic acid-associated renal tubular acidosis with decreased renal function in Crohn's disease. Digestion 58: 304–307
Calvino J et al. (1998) Mesalazine-associated tubulo-interstitial nephritis in inflammatory bowel disease. Clin Nephrol 49: 265–267
Baumer P et al. (1999) Severe chronic interstitial nephritis associated with Crohn's disease, but not with mesalazine? [French]. Gastroenterol Clin Biol 23: 1400–1402
Margetts PJ et al. (2001) Interstitial nephritis in patients with inflammatory bowel disease treated with mesalamine. J Clin Gastroenterol 32: 176–178
Unal A et al. (2008) Crohn's disease complicated by granulomatous interstitial nephritis, choroidal neovascularization, and central retinal vein occlusion. Intern Med 47: 103–107
Acknowledgements
Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Waters, A., Zachos, M., Herzenberg, A. et al. Tubulointerstitial nephritis as an extraintestinal manifestation of Crohn's disease. Nat Rev Nephrol 4, 693–697 (2008). https://doi.org/10.1038/ncpneph0955
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0955
This article is cited by
-
Crohn’s disease may promote inflammation in IgA nephropathy: a case–control study of patients undergoing kidney biopsy
Virchows Archiv (2022)
-
Long-term outcome of biopsy-proven idiopathic tubulointersitial nephritis with or without uveitis in children—a nationwide follow-up study
Pediatric Nephrology (2021)
-
Spectrum and prognosis of renal histopathological lesions in patients with inflammatory bowel disease: a cross-sectional study from a single center in China
Clinical and Experimental Medicine (2021)
-
The possible involvement of intestine-derived IgA1: a case of IgA nephropathy associated with Crohn’s disease
BMC Nephrology (2016)
-
Author's response to “Depth of inflammation in Crohn's disease”
Nature Reviews Nephrology (2009)