Nephrotic syndrome after treatment of Crohn′s disease with mesalamine: Case report and literature review

Firwana, Belal; Hasan, Rim; Chalhoub, Walid; Ferwana, Mazen; Kang, Jin-Yong; Aron, Joshua; Lieber, Joseph

doi:10.4103/2231-0770.94804

Cited by 19 publications

(4 citation statements)

References 6 publications

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“…Ambruzs et al reported 4 cases of CD with minimal change disease (5% [4/83]), 3 cases of which were currently taking 5-ASA [ 5 ]. Firwana et al reported a case of CD with minimal change disease with significant improvement in renal function after 5-ASA withdrawal [ 34 ]. Then, 5-ASA-associated interstitial nephritis has received extensive attention [ 5 , 33 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

The pathological and outcome characteristics of renal lesions in Crohn’s disease

Zhang

Dong

et al. 2022

BMC Nephrol

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Background The inflammatory bowel disease, containing Crohn’s disease and ulcerative colitis, was rare in the population, especially in the complication of kidney disease. A few studies had found proteinuria played a potential indicator of inflammatory bowel disease occurrence and activity. This study aimed to better define the histopathologic spectrum and study the outcome of renal disease in Crohn’s disease. Methods A retrospective study of 3557 Crohn's disease from January 1st, 2016 to July 1st, 2021 in the Sixth Affiliated Hospital of Sun Yat-sen University identified 20 (0.56% [20/3557]) patients who underwent kidney biopsy. All biopsy specimens were examined by standard procedures containing light microscopy, immunofluorescence, and electron microscopy. Results Twenty cases were shown in this review study. Subnephrotic proteinuria (30% [6 of 20]), persistent hematuria and proteinuria (25% [5 of 20]), and isolated hematuria with acanthocytes (25% [5 of 20]) were the main indications for kidney biopsy. The most common diagnosis was IgA nephropathy (70% [14/20]), followed by minimal change disease (10% [2/20]), acute interstitial nephritis (5% [1/20]), granulomatous interstitial nephritis (5% [1/20]), non-IgA mesangial proliferative nephritis (5% [1/20]) and thin basement membrane nephropathy (5% [1/20]). The Lee classification of IgA nephropathy was mostly II or III level. Glomerular mesangial hyperplasia was the most common pathologic manifestation according to the MEST-C Sore. After twelve-month treatment, the majority of patients turned to complete remission of renal disease by measuring proteinuria, while 3 patients still stayed in the relapse stage and 6 patients turned to partial remission by measuring hematuria. Conclusions IgA nephropathy is the most common kidney biopsy diagnosis in Crohn's disease. Renal damage in Crohn's disease mainly involves the glomerulus, especially the mesangial matrix. After the treatment, proteinuria might be in remission, but hematuria remains.

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Section: Discussionmentioning

confidence: 99%

The pathological and outcome characteristics of renal lesions in Crohn’s disease

Zhang

Dong

et al. 2022

BMC Nephrol

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“…It has been postulated that both conditions may follow a similar pathophysiologic course [23]. There have been a few reports of focal segmental glomerulosclerosis nephrotic syndrome in a patient with UC [24] and CD following mesalamine therapy in patients with nephrotic syndrome [25]. Nevertheless, the causal relationship between the two conditions is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting

Adeniyi

Odeghe

Olatona

et al. 2020

Cureus

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Introduction: Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children. The aim of this study was to increase the awareness of this emerging condition in African children and highlight the constraints of management in a resourcelimited setting like Nigeria.Methods: This study included an audit of children with IBD who were seen between January 2015 and February 2020 at the Lagos University Teaching Hospital (LUTH). The clinical records of children aged one to 16 years who presented with recurrent abdominal pain, weight loss, and gastrointestinal (GI) bleeding with clinical suspicion of IBD were reviewed. Clinical features, endoscopic findings, histopathologic findings, and treatment were documented.Results: Eight children with IBD were seen during the study period. The median age was 12.0 years (range: five to 15 years). The most common reported concerns in the children were chronic abdominal pain [seen in four patients (50%)] and bloody diarrhea [seen in three patients (42.30%)]. Weight loss and arthritis were seen in three (37.5%) and one (12.5%) children, respectively. Endoscopy confirmed two cases of Crohn's disease (CD), three cases of ulcerative colitis (UC), and three cases of indeterminate colitis (IC). The children with CD were treated with steroids and exclusive enteral nutrition, with one patient receiving methotrexate, while the UC and IC patients received 5-aminosalicylate therapy. Conclusion:Although IBD is uncommon in Nigeria, a high index of suspicion is vital to enable early diagnosis and appropriate treatment. Management in the African setting is severely constrained by limited access to endoscopy facilities and nonavailability of other effective treatment options such as biologic agents.

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“…UC was associated with NS after treatment of UC with mesalazine for 5 years. Firwana et al reported a case of NS after mesalazine treatment for Crohn’s disease [ 5 ]. He also reviewed six case reports of NS after the treatment of UC with 5-amino-salacylic acid derivatives.…”

Section: Case Presentationmentioning

confidence: 99%

“…Previous studies reported that UC patients treated with mesalazine were associated with nephrotic syndrome (NS) [ 5 ]. The relationship between mesalazine and NS is unclear.…”

Section: Introductionmentioning

confidence: 99%

Ulcerative colitis associated with nephrotic syndrome after treatment with mesalazine developed into rectal carcinoma: a case study

et al. 2016

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BackgroundPrevious studies reported that nephrotic syndrome is associated with ulcerative colitis (UC) patients treated with mesalazine. Dysplasia associated with UC often develops into colorectal carcinoma.Case presentationA 17-year-old man was referred to our hospital, complaining of diarrhea and bloody stool. Total colonoscopy (TC) was performed and total-type UC was diagnosed. After treatment with mesalazine for 5 years, a low-grade dysplasia (LGD) was detected in the rectum by histological analysis of a biopsy sample. One month later, he complained of dyspnea and edema. He was diagnosed with nephrotic syndrome and administered steroid and immunosuppressant treatment: cyclosporine and mizoribine. Eight years after LGD was detected, he complained of abdominal distension and pain. Stenosis of the upper rectum by an advanced rectal carcinoma was detected. Abdominal computed tomography showed a rectal tumor with multiple lymph node metastases. Transverse colostomy was performed surgically, followed by two cycles of modified FOLFOX6 and panitumumab. He safely underwent a total proctocolectomy with a stapled ileal pouch anal-canal anastomosis, total mesorectal and bilateral pelvic lymph node dissection, and temporary loop ileostomy. Metastases were observed in 25 lymph nodes microscopically. The pathological stage of rectal carcinoma was pT3N2bM1a. After one cycle of modified FOLFOX6 postoperatively, he was discharged from the hospital.ConclusionsA patient with UC associated with nephrotic syndrome was treated with mesalazine. LGD developed into an advanced rectal carcinoma after an 8-year interval. The use of immunosuppressants for the treatment of nephrotic syndrome might affect the development of rectal carcinoma.Trial registrationTrial registration: Case report registration #1626

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Nephrotic syndrome after treatment of Crohn′s disease with mesalamine: Case report and literature review

Cited by 19 publications

References 6 publications

The pathological and outcome characteristics of renal lesions in Crohn’s disease

The pathological and outcome characteristics of renal lesions in Crohn’s disease

Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting

Ulcerative colitis associated with nephrotic syndrome after treatment with mesalazine developed into rectal carcinoma: a case study

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