title: The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Kidney disease as a complication of inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), has been the subject of case reports. However, no cases series examining IBD and kidney disease has been published to date. This study aimed to evaluate a large series of kidney biopsy specimens from patients with IBD to better define the spectrum and relative frequencies of IBD-associated kidney pathology.
  
  
  METHODS
  A retrospective review of native kidney biopsy specimens obtained from March 2001 to June 2012 identified 83 patients with IBD. Standard processing of all biopsy specimens included light microscopy, immunofluorescence, and electron microscopy.
  
  
  RESULTS
  There were 45 cases of CD and 38 cases of UC represented. The most common indication for kidney biopsy was acute or chronic kidney failure (63% [52 of 83]) and nephrotic-range proteinuria (16% [13 of 83]). IgA nephropathy was the most common diagnosis (24% [20 of 83]), followed by interstitial nephritis (19% [16 of 83]), arterionephrosclerosis (12% [10 of 83]), acute tubular injury (8% [7 of 83]), proliferative GN (7% [6 of 83]), and minimal-change disease (5% [4 of 83]). When compared, the frequency of IgA nephropathy in IBD was significantly higher than in all other native renal biopsy specimens from the same time period (24% [20 of 83] versus 8% [2734 of 33,630]; P<0.001). Of the 16 cases of interstitial nephritis, 9 (56%) had current or recent past exposure to aminosalicylates, including all cases of granulomatous interstitial nephritis.
  
  
  CONCLUSIONS
  IBD is associated with a spectrum of kidney diseases most commonly affecting the glomerular and tubulointerstitial compartments. IgA nephropathy is the most frequent kidney biopsy diagnosis in IBD and has a significantly higher diagnostic prevalence compared with all non-IBD kidney biopsy specimens. This may reflect a common pathogenic mechanism. Although many cases of tubulointerstitial nephritis are related to aminosalicylate exposure, the possibility of a direct relationship with IBD cannot be ruled out.
authors.affiliation: Nephropath, Little Rock, Arkansas, †Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Ambruzs
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Walker
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Larsen
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects; D005921:Glomerulonephritis / Q000453:epidemiology / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology*; D007674:Kidney Diseases / Q000453:epidemiology* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D005765:Gastrointestinal Agents