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Immunoglobulin A Nephropathy in Association with Inflammatory Bowel Diseases: Results from a National Study and Systematic Literature Review
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Edité par CCSD ; Oxford University Press -
International audience. Abstract Background Little is known about clinical characteristics and kidney outcomes in patients with biopsy-proven immunoglobulin A nephropathy (IgAN) in a context of inflammatory bowel disease (IBD). Methods We conducted a retrospective multicentre study with a centralized histological review to analyse the presentation, therapeutic management and outcome of 24 patients suffering from IBD-associated IgAN relative to a cohort of 134 patients with primary IgAN without IBD. Results Crohn's disease and ulcerative colitis accounted for 75 and 25% of IBD-associated IgAN cases, respectively. IBD was diagnosed before IgAN in 23 cases (a mean of 9\,years previously) and was considered active at IgAN onset in 23.6% of patients. Hypertension was present in 41.7% of patients. The urinary protein:creatinine ratio exceeded 100\,mg/mmol in 70.8% of patients (mean 254\,mg/mmol). Estimated glomerular filtration rate (eGFR) was >60\,mL/min/1.73\,m2 in 13/24 patients and only 1 patient required dialysis. In the Oxford mesangial hypercellularity, endocapillary cellularity, segmental sclerosis and interstitial fibrosis/tubular atrophy with crescents classification of renal biopsies, 57% were M1, 48% E1, 76% S1, 57% T1\textendash 2 and 38% C1\textendash 2. Steroids were administered in 50% of cases. After a mean follow-up of 7.2\,years, 4 patients (16.7%) had a poor kidney outcome: end-stage renal disease (n\,=\,3) or a >50% decrease in eGFR from initial values (n\,=\,1). A similar evolution was observed in patients with primitive IgAN. Conclusions This first case series suggests that IBD-associated IgAN has frequent inflammatory lesions at onset and variable long-term outcomes.
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