An adolescent with IgA nephropathy and Crohn disease: pathogenetic implications

Abstract

We describe a patient with IgA nephropathy associated with Crohn disease. IgA nephropathy first appeared at the age of 10 years. Combined therapy with prednisolone, cyclophosphamide, warfarin, and angiotensin-converting enzyme inhibitor resulted in clinical improvement over the following year, and remission was maintained. At the age of 13 years, the patient developed Crohn disease and IgA nephropathy recurred. Significant increases in serum IgA were associated with progression of Crohn disease. An elemental diet combined with oral prednisolone resulted in clinical improvement of Crohn disease and in remission of nephropathy and normalization of serum IgA concentration. The clinical course of the two diseases was linked, suggesting a common pathogenetic mechanism involving an IgA immune response to mucosal challenge in the intestine.

The Histopathologic Spectrum of Kidney Biopsies in Patients with Inflammatory Bowel Disease

“…They described both clinical and pathologic remission of kidney disease concomitant with the treatment of symptoms of intestinal disease. Nineteen subsequent case reports in the literature have described IgAN in IBD (9,22,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). A majority of these patients had IgAN during onset or exacerbation of IBD, as well as clinical remission of kidney disease in conjunction with successful treatment of bowel inflammation.…”

IgA nephropathy in association with Crohn's disease: a case report and brief review of the literature

“…Various histological forms of glomerulonephritis associated with Crohn's disease are described, including four cases of membranoproliferative glomerulonephritis, 10-13 one case of mesangial proliferative glomerulonephritis, 14 two cases of membranous nephropathy, 15,16 one case of thin basement membrane disease, 17 one case of IgA antiglomerular basement membrane disease, 6 and nine cases of IgAN. [17][18][19][20][21][22][23][24][25] Renal manifestations occurred in the setting of active bowel disease in every case. Furthermore, it is of particular interest that proteinuria and renal function often improved in parallel under the treatment of the gastrointestinal disorder, suggesting a glomerulonephritis secondary to the inflammatory bowel disease, though a direct effect of the steroid treatment per se cannot be excluded.…”

“…17,22,23 The first report was published in 1984 by Hubert et al and involved two patients: one with ulcerative colitis and the other with Crohn's disease, who developed glomerulonephritis due to IgA mesangial deposits. 18 The age distribution in the reported cases is similar to that of patients with Crohn's disease without glomerulonephritis with a median of 22 years (range 10-36 years).…”

Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

“…Crohn's disease complicated with IgA nephropathy has been reported [16][17][18][19][20][21]. In most cases, onset or aggravation of IgA nephropathy coincided with the worsening of Crohn disease.…”

“…In most cases, onset or aggravation of IgA nephropathy coincided with the worsening of Crohn disease. In several cases, the nephropathy subsided with improvement of the intestinal disease [16][17][18][19]. It is speculated that mucosal inflammation in the intestine promotes exposure of immune cells to various antigens in food or bacteria, which provokes increases of polymeric IgA, leading to the development of immune complexes that accumulate in the glomerulus [16][17][18][19].…”