Glomerulopathies in patients with inflammatory bowel disease

Czech version

Authors: V. Teplan ^{1 3}; Honsová E. ⁴; Lukáš M. ¹
Authors‘ workplace: Klinické a výzkumné centrum pro idiopatické střevní záněty ISCARE a. s. a 1. LF UK Praha ¹; Subkatedra nefrologie, Institut postgraduálního vzdělávání ve zdravotnictví, Praha ²; Katedra interních oborů LF OU, Ostrava ³; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha ⁴
Published in: Gastroent Hepatol 2020; 74(1): 62-67
Category: Chapters from Internal Medicine: Case report
doi: https://doi.org/10.14735/amgh202062

Overview

Inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis often accompany one another. Recently, the association between immunologic illness and IBD, mainly in patients with glomerulonephritis, has attracted considerable interest. The most frequent example is mesangio-proliferative glomerulopathy with immunoglobulin A deposits, which is referred to as IgA nephropathy (Berger’s disease). Renal damage often presents as decreased renal function and frequently results in proteinuria, a characteristic of nephrotic syndrome. Specific situation occurs in IBD patients on biologic therapy and simultaneous immune-mediated renal disease (glomerulopathies) which is indicated also for immunosuppressive treatment. Currently, the treatment strategy involves simultaneous administration of biologic anti-tumor necrosis factor (TNF) drugs and immunosuppressants, but this strategy is empiric because its use depends on the clinical and laboratory features of both diseases. In IBD patients with a non-advanced renal pathology, biologic therapy of IBD continues in the same manner. In adverse renal disease patients, a switch in therapy from infliximab to vedolizumab is an option. In the case of relapsed renal disease with increasing proteinuria, nephrologists recommend full intensive immunosuppressive therapy with e.g., cyclophospamid (Endoxan iv) and corticosteroids (Methylprednisolon iv). In these situations, an interruption of biologic therapy with anti-TNF drugs is mandatory to minimize immunosuppressive effects and the risk of serious infection. However, clear rules and confirmatory studies are not yet available. Four clinical cases from clinical practice are briefly introduced and discussed.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no financial, advisory or other com mercial interests in relation to the subject matter.

Publication Ethics: This article/ manuscript has not been published or is cur rently be ing submitted for another review. The authors agree to publish their name and e-mail in the published article/ manuscript.

Dedication: The article/ manuscript is not supported by a grant nor has it been created with the support of any company.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

kidney – IBD – glomerulopathies – immunosuppression – biologic therapy

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