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Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Sep 25, 2024; 13(3): 96574
Published online Sep 25, 2024. doi: 10.5527/wjn.v13.i3.96574
Insights into renal and urological complications of inflammatory bowel disease
Anmol Singh, Tejasvini Khanna, Diksha Mahendru, Jasraj Kahlon, Vikash Kumar, Aalam Sohal, Juliana Yang
Anmol Singh, Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
Tejasvini Khanna, Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India
Diksha Mahendru, Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Jasraj Kahlon, Department of Internal Medicine, Abrazo Medical Center, Phoenix, AZ 85015, United States
Vikash Kumar, Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
Aalam Sohal, Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
Juliana Yang, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
Author contributions: Singh A, Sohal A, and Yang J conceptualized and designed the study. Singh A, Khanna T, Mahendru D, and Kahlon J conducted the literature review, interpreted data, created artwork, and drafted the original manuscript. Kuman V, Sohal A, and Yang J supervised the study and made critical revisions.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aalam Sohal, MBBS, Academic Fellow, Department of Hepatology, Liver Institute Northwest, 3216 NE 45th Pl Suite 212, Seattle, WA 98105, United States. aalamsohal@gmail.com
Received: May 13, 2024
Revised: July 1, 2024
Accepted: July 15, 2024
Published online: September 25, 2024
Processing time: 128 Days and 15.3 Hours
Abstract

Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.

Keywords: Inflammatory bowel disease; Glomerulonephritis; Amyloidosis; Extra-intestinal manifestations; Nephrotoxicity; chronic kidney disease

Core Tip: Renal manifestations have been described in 4%-23% of the patients with Inflammatory bowel disease, leading to significant morbidity and mortality. Glomerulonephritis, nephrolithiasis, amyloidosis, and tubulointerstitial nephritis are common with approximately 5%-15% of the patients developing chronic kidney disease. Serum markers such as creatinine levels, especially cystatin-c levels, should be used to monitor renal function, especially in patients receiving nephrotoxic medications such as aminosalicylates and TNF-α inhibitors.