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Published on: September 22, 2019
Crohn's Disease with Granulomatous Interstitial Nephritis as an Extraintestinal Complication from the Time of the
Naohiro Itoh1, Kenji Kasuno2, Motoko Yasutomi1
1Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Japan.
Insights
Granulomatous interstitial nephritis (GIN) is rare in inflammatory bowel disease. This case highlights a non-drug-induced GIN linked to Crohn's disease, involving macrophages and NF-κB pathway activation.
Area of Science:
- Nephrology
- Gastroenterology
- Immunology
Background:
- Granulomatous interstitial nephritis (GIN) is infrequently associated with inflammatory bowel disease (IBD).
- Most GIN cases are iatrogenic, often linked to medications.
- The non-drug-induced etiology and specific pathogenesis in IBD patients remain underexplored.
Purpose of the Study:
- To report a rare case of non-drug-induced GIN in a pediatric patient with Crohn's disease.
- To investigate the potential role of macrophages and the NF-κB pathway in the development of GIN in this context.
Main Methods:
- A 13-year-old male patient with symptoms of IBD underwent total colonoscopy and biopsy.
- Kidney biopsy was performed for diagnostic evaluation of nephritis.
- Immunohistochemical analysis of colon and kidney tissues was conducted to assess cellular infiltrates and protein expression.
Main Results:
- The patient was diagnosed with both Crohn's disease and non-drug-induced GIN.
- Both colon and kidney biopsies revealed the presence of macrophages.
- Epithelial cells in both tissues exhibited increased expression of IκBζ, a key regulator in the NF-κB signaling pathway.
Conclusions:
- Non-drug-induced GIN can occur in association with Crohn's disease.
- Macrophages and the NF-κB pathway, indicated by IκBζ expression, may play a significant role in the pathogenesis of GIN in Crohn's disease patients.
- Further research is warranted to elucidate the prevalence and mechanisms of GIN in IBD.
Abstract:
Granulomatous interstitial nephritis (GIN) has been reported in <0.5% of patients with inflammatory bowel disease, and most cases of GIN are drug-induced. A 13-year-old boy was referred for the evaluation of abdominal pain, diarrhea, and weight loss. The patient was diagnosed with non-drug-induced GIN and Crohn's disease based on total colonoscopy and a biopsy of the colon and kidney. Both tissues contained macrophages and increased epithelial expression of IκBζ, a protein involved in the nuclear factor kappa-light-chain-enhancer of activated B cells pathway. There may be more patients with GIN complicated by Crohn's disease than expected, and macrophages may be involved in the pathogenesis.
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