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. 2023 Nov 20;9(2):383-394.
doi: 10.1016/j.ekir.2023.11.011. eCollection 2024 Feb.

Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes

Federico Yandian  1 , Fernando Caravaca-Fontán  2 , Loren P Herrera Hernandez  3 , Maria José Soler  4 , Sanjeev Sethi  3 , Fernando C Fervenza  5
Affiliations

Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes

Federico Yandian et al. Kidney Int Rep. .

Abstract

Introduction: Kidney disease is a well-known extraintestinal manifestation (EIM) associated with inflammatory bowel disease (IBD), with a variety of underlying etiologies. However, little is known about the overall outcomes and predictors.

Methods: This is a retrospective, observational cohort study. Patients with IBD in whom a native kidney biopsy was performed at Mayo Clinic (Rochester, MN) between 1994 and 2022, were included. Demographic, clinical, and histologic characteristics of prognostic interest were collected. The main outcomes were kidney failure, disease remission, kidney function changes at last follow-up, and death.

Results: From a total cohort of 318 patients, we selected a study group of 111 patients followed-up with at our institution (45 ulcerative colitis [UC] and 66 Crohn's disease [CD]), with a mean age of 48 ± 17 years (40% females). IgA nephropathy (IgAN), chronic interstitial nephritis (CIN), and acute interstitial nephritis (AIN) were the most common diagnoses (22%, 19%, 13%, respectively). Median estimated glomerular filtration rate (eGFR) at presentation was 30 ml/min per 1.73 m2 (interquartile range [IQR]: 17-54) and urinary protein-to-creatinine ratio [UPCR] 0.8 g/g (0.3-3.4), without differences between IBD types. During a median follow-up of 59 months (12-109), 29 patients (26%) reached kidney failure. By multivariable analysis, the main predictors of kidney failure were age (hazard ratio [HR]: 1.04; P = 0.002), baseline eGFR (HR: 0.94; P = 0.003) and histologic chronicity score (HR: 4.01; P < 0.001). Therapeutic management varied according to underlying etiology. Global survival (kidney failure + death) was significantly better in patients who achieved complete or partial remission, or stabilization or improvement of kidney function.

Conclusion: One-fourth of patients with IBD with kidney disease may reach kidney failure, and the main determinants of this outcome is age, baseline eGFR, and degree of chronicity in kidney biopsy.

Keywords: IgA nephropathy; inflammatory bowel disease; interstitial nephritis; kidney failure; total chronicity score.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Summary of main etiologies of kidney disease in the total cohort (N = 138), and the cohort of patients with follow-up at our institution (n = 111).
Figure 2
Figure 2
(a) Evolution of eGFR according to the development of kidney failure at last follow-up; (b) Evolution of UPCR according to the development of kidney failure. Data are presented as median (interquartile range). eGFR, estimated glomerular filtration rate; UPCR, urinary protein-to-creatinine ratio.
Figure 3
Figure 3
Kaplan-Meier curves for kidney survival according to grades of histologic total disease chronicity score in kidney biopsy.
Figure 4
Figure 4
Kaplan-Meier curves for kidney survival according to IBD treatment modifications after kidney disease (KD) diagnosis. IBD, inflammatory bowel disease.
Figure 5
Figure 5
(a) Kaplan-Meier curves for global survival (kidney failure + death) according to remission status (complete or partial versus no remission); (b) Kaplan-Meier curves for global survival (kidney failure + death) according to changes in kidney function (stabilization or improvement versus declining kidney function).
See this image and copyright information in PMC

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