[Chronic inflammatory intestinal disease and nephritis]

Area of Science:

• Nephrology
• Gastroenterology
• Internal Medicine

Background:

• Inflammatory Bowel Disease (IBD) management often involves medications like Mesalazine (5-ASA) and Salazosulfapyridine (SASP).
• Renal complications are potential extraintestinal manifestations of IBD.
• The association between IBD therapies and specific renal pathologies requires further elucidation.

Observation:

• An 11-year-old Crohn's disease (CD) patient presented with interstitial nephritis and acute kidney failure after initiating 5-ASA and SASP treatment.
• Despite medication withdrawal, hemofiltration, and prednisone therapy, renal function showed only partial recovery (creatinine clearance 34 ml/1.73 m²/min).
• This case highlights a potential hyperergic-allergic reaction to SASP and 5-ASA leading to interstitial nephritis.

Findings:

• SASP and 5-ASA are implicated as potential causes of drug-induced interstitial nephritis in IBD patients.
• IBD itself can be associated with glomerulonephritis, possibly due to immune complex deposition.
• Both interstitial nephritis and glomerulonephritis in IBD can have chronic courses and require timely histological diagnosis.

Implications:

• Healthcare providers should consider renal surveillance in IBD patients treated with SASP/5-ASA.
• Early histological diagnosis is critical for managing renal manifestations in IBD.
• These findings do not necessitate avoiding SASP/5-ASA but underscore the importance of vigilant renal function monitoring.